O&P Almanac February 2018

The Magazine for the Orthotics & Prosthetics Profession

F E B R UARY 2018

CMS and OHMA Unveil Low-Volume Appeals Initiative

This Just In: OIG Investigates High Utilization of Off-the-Shelf Orthotic Codes P.22

P.18

How Will Tax Reform Impact O&P Facilities?

P.36

The Intersection of O&P Research and Real-World Design

At the

Summit PARALYMPIC ATHLETES GEAR UP FOR ULTIMATE COMPETITION P.24

P.44

Coverage of Replacement Devices and Liners P.64

E! QU IZ M EARN

2

BUSINESS CE

CREDITS

WWW.AOPANET.ORG

P.21

YOUR CONNECTION TO

EVERYTHING O&P

THE PR EM I ER M E E T IN G F OR ORT H OT IC, PROSTH ETIC, A N D PED ORTH IC PROFESSION A LS.

e c n e i r e p Ex

September 26-29, 2018

VANCOUVER CALL FOR PAPERS NOW OPEN! AOPA is accepting clinical, technician, symposia/instructional course, business, and pedorthic abstracts.

Submit by March 1 at

Vancouver is easy to explore during your time at the downtown Vancouver Convention Centre as there are many nearby top attractions.

• • • • • •

Capilano Suspension Bridge Vancouver Aquarium Forbidden Vancouver Stanley Park Horse-Drawn Tours Harbour Cruises & Events Flyover Canada

• Vancouver Lookout • Dr. Sun Yat-Sen Classical Chinese Garden • Vancouver Art Gallery • Science World • Grouse Mountain

bit.ly/present2018

Experience Beyond Vancouver’s unbeatable location makes it the perfect gateway to the rest of British Columbia and beyond, providing you with outstanding opportunities for pre- and post-conference travel.

• Whistler • Okanagan Valley • Jasper • Victoria • Banff • Cruise to Alaska

AOPAnet.org

#AOPA2018

Experience all the AOPA National Assembly has to offer while visiting Vancouver.

contents

FE B R UARY 2018 | VOL. 67, NO. 2

PHOTO: USA Hockey

24 | At the Summit Elite athletes from across the globe will head to PyeongChang, South Korea, next month to compete in the 2018 Paralympics. Meet four of the individuals who have spent years training for the chance to compete in the Winter Games—and learn how their clinicians have guided them along their journeys by aiding in componentry selection and designing unique prostheses.

By Lia K. Dangelico

ON THE COVER: Paralympic skier Stephani Victor

2

COVER STORY

FEATURES

22 | This Just In

OIG Targets Off-the-Shelf Orthoses The Office of Inspector General has announced an investigation into the codes for off-the-shelf (OTS) lumbosacral orthoses (L0648 and L0650) and knee orthoses (L1833). All three codes, which are part of the split code set that differentiates OTS orthoses from those that require the expertise of a certified orthotist or equivalent, have experienced abnormally high utilization as well as a significant number of improper payments over the past three years.

L0648 L1833

FEBRUARY 2018 | O&P ALMANAC

L0650

36

| Maximum Returns

O&P business owners can expect major changes regarding their taxes, thanks to the recently enacted Tax Cuts and Jobs Act. Companies of almost all types and sizes will see a percentage decrease in the rate of their taxable income and will need to understand the changes in the new law regarding various credits and deductions. Employers also need to be aware of changes to the individual tax brackets, and adjust paychecks according to guidance from the Internal Revenue Service.

By Christine Umbrell

contents

PRINCIPAL INVESTIGATOR Silvia Raschke, PhD............................44 Meet a prominent O&P researcher who has authored more than 30 publications, including a groundbreaking study on prosthetic foot and socket designs.

DEPARTMENTS Views From AOPA Leadership......... 4 Insights from AOPA board member Teri Kuffel, JD

AOPA Contacts.......................................... 6 How to reach staff

Numbers......................................................... 8 At-a-glance statistics and data

Happenings............................................... 10

COLUMNS

Research, updates, and industry news

Reimbursement Page..........................18

Battling the Backlog

Introducing the low-volume appeals initiative CE Opportunity to earn up to two CE credits by taking the online quiz.

CREDITS

Member Spotlight................................ 50 n

Kinetic Prosthetics

n

FLO-TECHÂŽ

P.10 People & Places........................................14 Transitions in the profession

AOPA News...............................................54 P.18

AOPA meetings, announcements, member benefits, and more

Welcome New Members ..................56 PAC Update............................................... 57 Marketplace..............................................58 Careers..........................................................61 Professional opportunities

Ad Index.......................................................61 P.50

Calendar..................................................... 62 Upcoming meetings and events

Ask AOPA.................................................. 64 P.52

Coverage of replacement devices and liners

O&P ALMANAC | FEBRUARY 2018

3

VIEWS FROM AOPA LEADERSHIP

Specialists in delivering superior treatments and outcomes to patients with limb loss and limb impairment.

Why Patients Are Important Advocates

L

AST MONTH, WHEN O&P executives gathered at AOPA’s Leadership Con-

ference in Florida, we talked about the proverbial “crystal ball,” how to make change happen, and what drives industry “blue-sky thinking.” Not surprisingly, the broad theme of the weekend kept returning focus to those in need of O&P care, our patients.

Without that crystal ball, how do we make change happen with our payors, in our states, and at the federal government? We must continue to advocate for our patients and educate those in power. We must continue to tell them why it is important for our patients to have access to O&P devices that meet their unique needs. As we continue to advocate and educate through our lobbying efforts, we must remember that it is far more effective to show regulators and legislators what we are talking about.

Here’s a quick, real-life example of how “showing them” has been effective in Minnesota. After spending a few years educating and lobbying in-state for the Minnesota O&P Licensure Act, we realized our legislators needed to hear from our patients rather than practitioners and business people. I will never forget the pivotal meeting that led to our successful mission of O&P licensure in Minnesota.

We asked Rob R., an above-knee amputee, to join us for a scheduled 15-minute meeting with an influential Republican state representative. Our prior conversations in his office had not gone well, and in all honesty, we were about ready to hang up the towel for yet another year. We prepared Rob with the typical scenario: “We’ll introduce you, talk shop, talk policy, and then ask you to tell a bit about yourself.” We walked in and before we could say one word, the representative said, “I only want to hear from one person in the room, him.” He was pointing to Rob. He asked Rob a series of simple, relevant questions about what had happened to him, what he did for work and fun, how he gets around, and ultimately how a Minnesota state representative could help make a difference in his life.

Our influential Republican state representative ended the meeting on his own terms, with the parting words that he would co-sponsor our O&P licensure bill and get others to do so as well. He thanked us for bringing Rob and told us he’s what matters most in this scenario.

So, in order to see a bit of blue sky, we must realize the importance of our patients as advocates. We must continue to advocate for and with them as we educate those in power in order to help effectuate change.

Next month, in Washington, DC, we all have the opportunity to meet with our legislators through the AOPA Policy Forum. Please join us March 7-8, and if possible, please bring along a patient, a colleague, or a friend who wears an O&P device. The result might be a better conversation, with a bit of blue sky, that just might lead to effective change in the lives of our patients.

Teri Kuffel, JD, is a member of AOPA’s Board of Directors.

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FEBRUARY 2018 | O&P ALMANAC

Board of Directors OFFICERS President Jim Weber, MBA Prosthetic & Orthotic Care Inc., St. Louis, MO President-Elect Chris Nolan Ottobock, Austin, TX Vice President Jeffrey Lutz, CPO Hanger Clinic, Lafayette, LA Immediate Past President Michael Oros, CPO, FAAOP Scheck and Siress O&P Inc., Oakbrook Terrace, IL Treasurer Jeff Collins, CPA Cascade Orthopedic Supply Inc., Chico, CA Executive Director/Secretary Thomas F. Fise, JD AOPA, Alexandria, VA DIRECTORS David A. Boone, MPH, PhD Orthocare Innovations LLC, Edmonds, WA Jeffrey M. Brandt, CPO Ability Prosthetics & Orthotics Inc., Exton, PA Mitchell Dobson, CPO, FAAOP Hanger Clinic, Grain Valley, MO Traci Dralle, CFM Fillauer Companies, Chattanooga, TN Teri Kuffel, JD Arise Orthotics & Prosthetics Inc., Blaine, MN Dave McGill Össur Americas, Foothill Ranch, CA Rick Riley Thuasne USA, Bakersfield, CA Brad Ruhl Ottobock, Austin, TX

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AOPA CONTACTS

American Orthotic & Prosthetic Association (AOPA) 330 John Carlyle St., Ste. 200, Alexandria, VA 22314 AOPA Main Number: 571/431-0876 AOPA Fax: 571/431-0899 www.AOPAnet.org

Publisher Thomas F. Fise, JD Editorial Management Content Communicators LLC

Our Mission Statement Through advocacy, education, and research, AOPA improves patient access to quality orthotic and prosthetic care.

Advertising Sales RH Media LLC Design & Production Marinoff Design LLC Printing Sheridan

Our Core Objectives AOPA has three core objectives—Protect, Promote, and Provide.

These core objectives establish the foundation of the strategic business plan. AOPA encourages members to participate with our efforts to ensure these objectives are met.

EXECUTIVE OFFICES

REIMBURSEMENT SERVICES

Thomas F. Fise, JD, executive director, 571/431-0802, tfise@AOPAnet.org

Joe McTernan, director of coding and reimbursement services, education, and programming, 571/431-0811, jmcternan@AOPAnet.org

Tina Carlson, CMP, chief operating officer, 571/431-0808, tcarlson@AOPAnet.org Don DeBolt, chief financial officer, 571/431-0814, ddebolt@AOPAnet.org MEMBERSHIP & MEETINGS Kelly O’Neill, CEM, manager of membership and meetings, 571/431-0852, koneill@AOPAnet.org Lauren Anderson, manager of communications, policy, and strategic initiatives, 571/431-0843, landerson@AOPAnet.org Betty Leppin, manager of member services and operations, 571/431-0810, bleppin@AOPAnet.org Yelena Mazur, membership and meetings coordinator, 571/431-0876, ymazur@AOPAnet.org Ryan Gleeson, assistant manager of meetings, 571/431-0876, rgleeson@AOPAnet.org AOPA Bookstore: 571/431-0865

Devon Bernard, assistant director of coding and reimbursement services, education, and programming, 571/431-0854, dbernard@AOPAnet.org SPECIAL PROJECTS Ashlie White, MA, manager of projects, 571/431-0812, awhite@AOPAnet.org Reimbursement/Coding: 571/431-0833, www.LCodeSearch.com

O&P ALMANAC Thomas F. Fise, JD, publisher, 571/431-0802, tfise@AOPAnet.org Josephine Rossi, editor, 703/662-5828, jrossi@contentcommunicators.com Catherine Marinoff, art director, 786/252-1667, catherine@marinoffdesign.com Bob Heiman, director of sales, 856/673-4000, bob.rhmedia@comcast.net Christine Umbrell, editorial/production associate and contributing writer, 703/6625828, cumbrell@contentcommunicators.com

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FEBRUARY 2018 | O&P ALMANAC

SUBSCRIBE O&P Almanac (ISSN: 1061-4621) is published monthly by the American Orthotic & Prosthetic Association, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314. To subscribe, contact 571/431-0876, fax 571/431-0899, or email landerson@AOPAnet.org.

Yearly subscription rates: $59 domestic, $99 foreign.

All foreign subscriptions must be prepaid in U.S. currency, and payment should come from a U.S. affiliate bank. A $35 processing fee must be added for non-affiliate bank checks. O&P Almanac does not issue refunds. Periodical postage paid at Alexandria, VA, and additional mailing offices.

ADDRESS CHANGES POSTMASTER: Send address changes to: O&P Almanac, 330 John Carlyle St., Ste. 200, Alexandria, VA 22314.

Copyright © 2018 American Orthotic and Prosthetic Association. All rights reserved. This publication may not be copied in part or in whole without written permission from the publisher. The opinions expressed by authors do not necessarily reflect the official views of AOPA, nor does the association necessarily endorse products shown in the O&P Almanac. The O&P Almanac is not responsible for returning any unsolicited materials.

All letters, press releases, announcements, and articles submitted to the O&P Almanac may be edited for space and content. The magazine is meant to provide accurate, authoritative information about the subject matter covered. It is provided and disseminated with the understanding that the publisher is not engaged in rendering legal or other professional services. If legal advice and/or expert assistance is required, a competent professional should be consulted.

Advertise With Us! Reach out to AOPA’s membership and more than 11,800 subscribers.

Engage the profession today. Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac18 for advertising options!

INTRODUCING THE friction brake knee

The Guardian knee is a lightweight mechanical knee joint featuring a friction brake for stance control, stance flexion, and extension assist. The knee is best suited as a rehabilitation tool for new patients to learn standing and walking during the rehabilitation process, and as a permanent knee for low-impact patients. It provides the prosthetist easy adjustability for patient gait-matching without the need to remove the prosthesis.

The Guardian also has a remote lock feature that can be disengaged as the patient progresses to provide the full 145 degrees of anatomical motion.

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NUMBERS

2018 Paralympic Games Hundreds of athletes expected for the Winter Games

PARTICIPANTS

Competitors and spectators will travel to PyeongChang, South Korea, March 9-18, for the 2018 Winter Paralympic Games. Athletes will compete in six sports—alpine skiing, biathlon, crosscountry skiing, ice hockey, snowboarding, and wheelchair curling—for a total of 80 medals. For details about several of the competitors and their clinicians, read “At the Summit” on page 24.

SNOWBOARD

670

ALPINE SKIING

Two

24 Percent

Athletes expected to compete.

NORDIC SKIING

30

Number of snowboard events: snowboard cross and banked slalom.

Three

Two

Two

800 Meters and Up to 20 Kilometers

Distance of cross-country races, depending on class and gender.

9

10

SAT

SUN

11

MON

12

Seed 2

United States—top seed in Group B, which also includes South Korea, Czech Republic, and Japan.

• General game

Medal competition

13

TUES

WED

14

TH

15

FRI

16

SAT

17

18

SUN

•

Alpine Skiing Biathlon Cross-Country Skiing Ice Hockey

•

•

•

•

•

•

•

•

•

•

•

•

•

•

Snowboard Wheelchair Curling Closing Ceremony SOURCE: www.pyeongchang2018.com/en/paralympics

8

FEBRUARY 2018 | O&P ALMANAC

•

SOURCES: International Paralympic Committee; www.teamusa.org.

Opening Ceremony

Canada—top seed in Group A, which also includes Norway, Italy, and Sweden.

Disciplines: cross country and biathlon.

Technical disciplines: slalom and giant slalom.

FRI

Seed 1

Medal events.

2018 Paralympic Games Schedule of Events

March 2018

ICE HOCKEY

Speed disciplines: downhill, super-G, and super combined.

Number of runs each athlete makes; the fastest run determines the results.

Number of tickets available for spectators.

38

Medal events.

Three

220,000

Increase in number of expected athletes compared to Sochi 2014.

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Join the team on Instagram at @fillauerallproallstars.

www.fillauer.com Photo courtesy of Brian Mouridsenas . Š 2018 Fillauer LLC

Happenings RESEARCH ROUNDUP

Colorado Researchers Develop ‘Soft’ Robots for Prosthetic Applications

Members of the Keplinger Research Group of mechanical engineering students at the University of Colorado—Boulder showcase their research into soft robots for artificial muscle.

imagine them as being laid out in a forearm, and then they could control the digits of an artificial hand,” said Shane Mitchell, co-author of the study.

“We draw our inspiration from the astonishing capabilities of biological muscle,” said Christoph Keplinger, senior author of both papers and an assistant professor in the Department of Mechanical Engineering. “HASEL actuators synergize the strengths of soft fluidic and soft electrostatic actuators, and thus combine versatility and performance like no other artificial muscle before. Just like biological muscle, HASEL actuators can reproduce the adaptability of an octopus arm, the speed of a hummingbird, and the strength of an elephant.”

The devices are low-cost, and can be made for about 10 cents each, according to the researchers. Future research will focus on optimizing materials and exploring advanced fabrication techniques to enable additional practical applications.

Online Scaling Factor Improves Control of Robotic Arm University of Pittsburgh researchers have added an online scaling factor to a brain-computer interface (BCI) model to increase accuracy in users’ control of robotic arms. The researchers worked with two tetraplegic subjects who used BCI to control a neuroprosthetic robotic arm to attempt to reach and grasp objects. The subjects’ ability to perform the tasks was improved when the researchers added an online scaling factor to the BCI model. Their research provides a generalizable BCI control method and explores neural changes in the motor cortex.

In the first phase of the study, the researchers, who are associated with the university’s Rehab Neural Engineering Labs, implanted intracortical microelectrode arrays into each subject’s motor cortex; these arrays are designed to record from neural populations. The subjects then took part in virtual reality training 10

FEBRUARY 2018 | O&P ALMANAC

so the BCI decoder could correctly interpret neural activity from each subject, and communicate with the robotic arm, and perform a calibration reaching task to train the decoder.

The subjects were subsequently asked to perform three tasks in a real environment: reaching and grasping a cylindrical object, reaching with and closing the robotic hand, and transporting an object 20 centimeters.

The researchers were able to improve subjects’ performance in the tasks by quantifying the differences in neural firing during robotic grasping both with and without an object, and then correcting for these neural changes. The research, “Motor Cortical Activity Changes During Neuroprosthetic-Controlled Object Interaction,” was published in the December 2017 edition of Scientific Reports.

PHOTOS: Glenn Asakawa/University of Colorado

Scientists in the Keplinger Research Group at University of Colorado—Boulder have developed hydraulically amplified selfhealing electrostatic (HASEL) actuators, designed to be used as soft robot materials, such as artificial muscles. The devices, which are made from inexpensive plastic and are filled with an electrically insulated liquid, change shape when voltage runs through them. The oil inside the HASEL muscles can withstand electricity, allowing the devices to potentially self-heal.

The versatility of the devices may enable artificial muscles and a next generation of prosthetic limbs, according to the researchers.

The HASEL actuators can be formed into different shapes and sizes for specific purposes.

For example, the Peano-HASEL actuator is made of three small, rectangular pouches strung together, and it contracts with voltage, similar to a biological muscle. This device is designed to grasp delicate objects without breaking them. Two other designs were detailed in separate papers in the journals Science and Science Robotics.

The scientists suggest that the actuators could offer more human-like movements if used in prostheses. “You could

HAPPENINGS

Researchers Study How Brain Identifies Different Terrains

PHOTO: University of Houston

Researchers at the University of Houston are mapping brain activity with the goal of improving prosthetic designs for easier navigation of complex settings. The research team tracked the brain activity of 10 able-bodied volunteers, each of whom was asked to wear a 64-channel skullcap. The subjects completed 20 trials that involved walking a course made of several types of terrain, including level ground as well as ramps and staircases. Using full-body motion capture technology, the researchers collected data about the lower-limb muscular activity of the participants.

The researchers mapped the signals back to the brain to determine how specific parts of the brain are involved in discrete tasks. “Our results showed that the changes of spectral power in neural sources localized to the posterior parietal cortex and sensorimotor cortex are associated with the level of motor task demands,” the researchers wrote. “Additionally, our results presented evidence that electrocortical amplitude

modulations, relative to average gait cycle, are correlated with the level of difficulty in locomotion tasks. These findings extend our understanding of cortical dynamics of human walking at different levels of locomotion task demands.”

Several areas of the brain are involved in mobility, according to the researchers.

The next step in the project, which is being funded by a grant from the National Science Foundation, will be to translate the findings to a high-tech prosthetic leg that has been developed at the University of North Carolina. The prosthesis is designed to automatically adjust to different terrains via brain-machine interface. The research also may be used to improve assistive devices, such as powered wheelchairs.

Florida Inventor Develops Games To Aid in Stroke Rehabilitation

PHOTOS: Vince Macri

Vince Macri, a Tallahassee, Floridabased inventor, has developed the Pre-Action Games and Exercises (PAGE) computer games program to assist stroke and traumatic brain injury survivors in their rehabilitation. The system combines a virtual gaming experience with an orthotic assistive device to help users retrain their affected limbs.

“We have focused on providing a tool to allow control of a virtual extremity in order to begin to rebuild the process of communicating from the brain to the extremities,” said Macri, who has published research on computer-based virtual anatomical interactivity. “Individuals who are impaired still have the ability to think about a movement. We make it possible to put that movement thought into a virtual movement action using our

on-screen games.” Playing the games can help contribute to “rebuilding connections between the brain and the impaired body part,” he said. “We make it easy and fun for people to repeat brain exercises and physically exercise” the impaired body part.

Macri has leveraged 3-D-printing technology to develop a simple powered orthotic device that can be affixed to an impaired body part and be used in conjunction with the PAGE games.

“The orthotic is 100 percent driven by the gaming system,” he explained.

“When the user controls the virtual hand, that signals the powered orthotic device to make the same movement.”

Macri is still in the research and development phase of creating the PAGE system, and is exploring additional orthotic options for the system.

O&P ALMANAC | FEBRUARY 2018

11

HAPPENINGS

SURVEY CENTRAL

Shirley Ryan AbilityLab Seeks Input From COs and PTs

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FEBRUARY 2018 | O&P ALMANAC

NATIONAL ASSEMBLY NEWS

Take the Train for the Best Views As you plan your travel to the 2018 AOPA National Assembly in Vancouver, September 26-29, consider making the journey part of the adventure by taking the train! Amtrak has offered a 10 percent discount to our attendees.

Travel from Seattle to Vancouver via the Amtrak Cascades route for a gorgeous four-hour journey, to take in more sights and potentially get a more convenient flight. Seattle offers direct flights to and from Miami, Tucson, Nashville, and other big cities. The Amtrak Cascades route also travels to Portland and terminates in Eugene, Oregon. As an added bonus, you won’t stand in any customs or passport control lines— they will come to you on the train!

Visit bit.ly/vancouvertravel for more information, the discount code, and additional travel tips.

THE LIGHTER SIDE

PHOTOS: Getty Images/fotoVoyager/CampPhoto; MAP: Jkan997 CC BY-SA 3.0, via Wikimedia Commons

The Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago, is conducting a research study to obtain input from certified orthotists and physical therapists about quality-of-care indicators for custom ankle-foot orthosis (AFO) users for its project, “Enhancing Quality of Orthotic Services With Process and Outcome Information,” Northwestern University IRB # STU00203034. This project aims to improve the quality of services for custom AFO users by identifying indicators of high-quality services.

The survey takes about 15-25 minutes to complete and can be found at bit.ly/afosurvey. Contact Jamal Spraggins at 312/238-4856 or jspraggins@sralab.org or Ontonio Jackson-Lucas at 312/238-3050 or ojacksonlu@sralab.org with any questions.

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PEOPLE & PLACES PROFESSIONALS ANNOUNCEMENTS AND TRANSITIONS

Shawn Brown, CPO, has been selected to serve as president of SRT Prosthetics and Orthotics LLC. Brown succeeds Sam Santa Rita, CP, who, along with his wife Julie, founded SRT in January 2002. Brown joined SRT in May of 2003 as a clinician. He has served as a clinical manager, regional manager, and most recently as SRT’s chief operations officer while remaining active in patient care.

An abstract by David Speers, CPO, LPO, has been selected as a Howard R. Thranhardt Lecture Series Award winner by the American Academy of Orthotists and Prosthetists.

Speers will present on “Functional Bracing for Treatment of Pediatric Diaphyseal Femoral Fractures: An Alternative to Spica Casting?” at the Academy’s 44th Annual Meeting and Scientific Symposium on Feb. 15, 2018, in New Orleans.

During his work as an orthotist/prosthetist at Scheck & Siress in Schaumburg, Illinois, Speers helped develop a femoral fracture brace with orthopedic surgeons to manage pediatric femur fractures in children 0-5 years old to replace the need for a hip spica cast.

The American Academy of Orthotists and Prosthetists has announced the recipients of the 2018 Academy awards. The awards will be presented during the 44th Academy Annual Meeting & Scientific Symposium, to be held Feb. 14–17, 2018, in New Orleans. “The Academy awards recognize those members who have distinguished themselves through their personal commitment to advancing the interests of the O&P profession and the patients we serve,” said Alicia J. Davis, MPA, CPO, FAAOP(D), president of the Academy Board of Directors. The following individuals will be recognized: • Gary Bedard, CO, FAAOP, clinical application liaison for Becker Orthopedic, will be honored with the Titus-Ferguson Award, the highest level of recognition bestowed upon a clinician or academician Gary Bedard, CO, whose accomplishments and contributions FAAOP have made a significant impact on the growth and development of the profession.

• Keith Smith, CO, LO, FAAOP, an orthotist at the Orthotic and Prosthetic Lab in St. Louis, will receive the Distinguished Practitioner Award in recognition of his personal dedication and leadership to the advancement of the Academy and the O&P profession.

• J. Chad Duncan, PhD, and Susan Spaulding, MS, CPO, FAAOP, will receive Outstanding Educator Awards.

Duncan is an associate professor at Northwestern University’s Feinberg School of Medicine in Chicago, and Spaulding is a lecturer in the Department of Rehabilitation Medicine at the University of Washington in Seattle.

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FEBRUARY 2018 | O&P ALMANAC

• Steven Schulte, CP, LP, FAAOP, and Jerome Voisin, CP, will receive Clinical Commitment Awards in recognition of their quiet commitment to the American Board for Certification in Orthotics, Prosthetics, and Pedorthics Code of Professional Responsibility. Schulte is the co-owner of Prosthetic Care in Georgia and has been serving the O&P and medical professions for more than 20 years. Voisin, whose award will be presented posthumously, owned a successful prosthetic care practice in Houma, Louisiana, for more than 30 years.

• The 2018 Research Award will be presented to Levi Hargrove, PhD, for his outstanding research in the field of O&P. He is the director of the Center for Bionic Medicine at the Shirley Ryan AbilityLab in Chicago and an associate professor in the Department of Physical Medicine and Rehabilitation and the McCormick School of Engineering at Northwestern University.

• Aaron Holm, founder and president of Wiggle Your Toes, will receive the Mohammed Amin Award for Humanitarian Service in recognition of his commitment Aaron Holm and service to the amputee community.

• In recognition of their knowledge of and dedication to the O&P profession, Honorary Academy membership will be awarded to Jack Richmond, president and chief executive officer of the Amputee Coalition, and Yeongchi Wu, PhD, a faculty member in Jack Richmond Northwestern University’s Feinberg School of Medicine.

IN MEMORIAM

Robert Eugene Teufel Robert Eugene Teufel, 78, of Elizabethtown, Pennsylvania, passed away unexpectedly on Jan. 7, 2018, in Florida. Teufel, who at one Robert Eugene time was a certified prosthetist and orthotist, Teufel owned Teufel Orthotic-Prosthetic Associates, where he worked for 48 years and helped many people.

He was a member at Evangelical Free Church of Hershey, then later was a regular attendee at LCBC Church.

Teufel was known as a generous, kind, and hard-working man who was always making a new friend. An avid golfer and fisherman, he loved sports and games of all kinds. He especially enjoyed watching his children and grandchildren play. He always had a joke to tell and some candy to give away.

His family requests donations be sent to The Michael J. Fox Foundation for Parkinson’s Research at michaeljfox.org or P.O. Box 5014, Hagerstown, MD 21741.

PEOPLE & PLACES BUSINESSES

Scheck & Siress has announced two new shareholders: Jason Wening, MS, CPO, LPO, FAAOP, and Lakshmi Narayan Shandilya, CPO, LPO, are the newest shareholders of the firm.

Wening, who completed his O&P training at Northwestern University and joined Scheck & Siress in 2005, brings a unique perspective to patient care; he is both a bilateral amputee and a biomechanist. He combines his personal understanding of wearing a prosthetic device with his knowledge of human movement and biomechanics to provide devices that meet the unique needs of individual patients, according to Scheck & Siress.

Shandilya, who has more than 15 years of experience in O&P, attends the ambulatory rehab amputee, neuro-rehab, spinescoliosis, and pediatric orthopedic clinics each week at the University of Illinois Hospital & Health Sciences System in Chicago. He received his bachelor of science degree in O&P from Bombay University (All India Institute of Physical Medicine and Rehabilitation, Mumbai India) and completed his postgraduate program in orthotics at Northwestern University in Chicago.

“As one of the very few group practices in orthotics and prosthetics in the country, we strongly believe in keeping alive our tradition of recognizing quality practitioners and future business leaders as an integral part of our nearly 65-year success story,” said Michael H. Oros, CPO, FAAOP, president and chief executive officer of Scheck & Siress.

Scheck & Siress

Prosthetics. Orthotics.

ANNOUNCEMENTS AND TRANSITIONS

The Amputee Coalition has added two new members to its Board of Directors: John Register and William Passig Perno, MBA, are now serving three-year terms. Board leadership shifts include John “Mo” Kenney, CPO, LPO, FAAOP, stepping into the role of board chair and Jeff Cain, MD, serving as vice chair.

Orthotic Prosthetic Group of America (OPGA) has announced a new partnership with Nymbl Systems. The arrangement provides OPGA’s members with access to Nymbl’s practice management system at a discounted rate. Nymbl’s functionality reportedly allows practitioners to access patient records, submit insurance claims, schedule appointments, and purchase supplies via mobile device.

RJ Rosenberg Orthopedic Lab in Cincinnati recently held its first Technology Day under the direction of Ryan Spill, CP. Mathew Jury, an inventor from New Zealand of a new prosthesis, The TASKA™ Hand, was a special guest at the event. Several upper-limb-loss patients demonstrated the waterproof hand for local media outlets.

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FEBRUARY 2018 | O&P ALMANAC

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REIMBURSEMENT PAGE

By DEVON BERNARD

Battling the Backlog

E! QU IZ M

A look at the low-volume appeals initiative and other actions being taken to reduce the accumulation of appeals

Editor’s Note—Readers of CREDITS Reimbursement Page are eligible to earn two CE credits.

After reading this column, simply scan the QR code or use the link on page 21 to take the Reimbursement Page quiz. Receive a score of at least 80 percent, and AOPA will transmit the information to the certifying boards.

CE

T

HE U.S. DEPARTMENT OF Health and Human Services (HHS), the department in charge of CMS and the Office of Medicare Hearing and Appeals (OMHA), has implemented three strategies to address and decrease the backlog of appeals at the administrative law judge (ALJ) level and improve the Medicare appeals process. The three steps include investment of resources, administrative actions, and legislative actions. These strategies have led to small changes, like the simplification of the ALJ forms, as well as the creation of new auditing practices.

Previous installments of Reimbursement Page have covered some of the actions that have been taken as part of HHS’s three-pronged approach. This month, we recap these three strategies and provide some information on the newest action: the low-volume appeals initiative that takes effect this month.

Resources and Administrative Actions

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2

CREDITS P.21

in 106,000 additional dispositions a year. In previous years, OMHA has used additional funding to expand the number of field offices—two in recent years—and increase the number of ALJs. Regarding the second strategy, administrative actions, several of these are being taken to reduce the number of pending appeals and implement new strategies to alleviate the current backlog and encourage resolution of appeals earlier in the process. These include some of the recent changes to the recovery audit contractor program and the introduction and use of prior authorization. As a reminder, at this time prior authorization is not available for orthotic and prosthetic claims.

Another example of an administrative action being taken is the durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) Telephone & Reopenings Discussion Demonstration project, currently under way only in Jurisdictions C and D. The demonstration project allows providers/suppliers to interact directly with the medical review staff of the qualified independent contractor handling the second level of appeals. The project allows the supplier/ provider to submit additional documentation and possibly receive some guidance on CMS policies and requirements, and reverse the claim denial. The project has proven to be very successful; preliminary results show that suppliers/ providers that have taken part have seen an 80 percent or higher overturn rate, resulting in fewer claims/appeals being escalated to the ALJ level of appeal.

PHOTO: Getty Images

HHS’s first strategy, investment of resources, focuses on resources being invested at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog. At the start of 2016, there were 77 ALJs; today, there are 92 qualified ALJs hearing appeals, plus a number of attorney adjudicators. OMHA’s FY 2018 budget request includes an increase of $135 million in funding; these funds would allow OMHA to increase the number of ALJs by 106 (to 198 total), resulting

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Target, Probe, and Educate The Target, Probe, and Educate (TPE) program focuses on a select set of high-risk claims and providers/suppliers and encourages resolution of appeals earlier in the process.

TPE consists of potentially three rounds of prepayment reviews, and each round involves between 20 and 40 claims. If the results of the first round of reviews are deemed acceptable, the provider/supplier receives a notice that it will be removed from the audit pool for a period of one year. If the results are not acceptable, the provider/supplier is scheduled for a personalized education session with the appropriate Medicare administrative contractor claims review department. During the education session, common errors and strategies to improve the error rate are discussed. After the personalized education session is complete, a second round of prepayment reviews will take place, about six to eight weeks after the first education session.

If, after the second round of reviews and subsequent education session, the results are still not acceptable, a third round may take place.

During each round of prepayment review, providers have the opportunity to be removed from the audit pool if their results are considered acceptable.

However, if after three rounds a participant still has a high error rate, that supplier/provider may be referred to CMS for additional action, which could include extrapolations, a referral to a recovery auditor, or other actions.

In addition, the Target, Probe, and Educate program has been instituted to focus the durable medical equipment Medicare administrative contractor (DME MAC) audit efforts on a select set of high-risk claims and providers/suppliers. The program encourages resolution of appeals earlier in the process. (See sidebar, “Target, Probe, and Educate.”)

The Newest Administrative Action

The most recent example of an administrative action designed to reduce the number of pending appeals is the implementation of the low-volume appeals (LVA) initiative. The LVA allows for certain eligible claims pending appeal to be settled quickly for a single lumpsum payment.

If you wish to partake in the LVA, you must determine if you are eligible and if any of your pending appeals are eligible.

To be eligible, you must have less than 500 appeals pending at either the ALJ or the Medicare Appeals Council levels (the third and fourth level of appeals, 20

FEBRUARY 2018 | O&P ALMANAC

respectively) as of Nov. 3, 2017; and you may not currently be in bankruptcy or planning to file for bankruptcy. The 500 total is across all National Provider Identifier (NPI) numbers associated with your organization’s tax identification number. In addition, if you are subject to any false claims investigations or any other civil or criminal investigations, you may not be eligible.

Appeals are eligible under the following conditions: • Each appeal has been properly filed in a timely manner and is pending a hearing at the ALJ or Appeals Council level as of Nov. 3, 2017.

• The claims in the appeals were denied by a Medicare contractor and remain fully denied (no partial denials).

• The claims included in the appeals are not part of an extrapolation, and each appeal has a total billed amount—not the allowable amount—of $9,000 or less.

If you and your appeals meet these eligibility requirements, the next step

is to submit an expression of interest (EOI) by the established deadlines.

The deadlines for EOI submission are based on your NPI number, and as such you must submit a separate EOI for each NPI. If your NPI ends in an even number (0, 2, 4, 6, 8), the EOI will be accepted by CMS between Feb. 5, 2018, and March 9, 2018. If your NPI ends in an odd umber (1, 3, 5, 7, 9), your EOI must be submitted between March 12, 2018, and April 11, 2018. Once your EOI is received, CMS will review your eligibility.

Within 30 days you should receive a response indicating you are eligible or ineligible. If you are deemed ineligible, you may challenge the decision; if you’re found eligible, CMS will email you an administrative agreement and a spreadsheet with all of your eligible appeals.

You will have the opportunity to review the agreement and all of the selected eligible appeals for accuracy.

If you disagree with the appeals listed on the spreadsheet, you may submit an eligibility determination request (EDR) and argue to have appeals added or removed. The EDR should be submitted within 15 days, and CMS will respond to your EDR within 30 days. If you are willing to accept the agreement and the original/revised spreadsheet is accurate, you must sign the agreement and return it within 15 days. If you don’t submit the signed agreement within 15 days, either because you forgot or you no longer wish to be part of the LVA, you will be removed from the LVA settlement process.

If you sign the agreement and approve the appeals spreadsheet, CMS will then countersign the agreement and the final steps of the settlement process will take place. One final review of your appeals eligibility takes place, and your eligible appeals are removed from the active or formal appeals process. At this time, your final settlement amount is calculated, and you should receive your final payment within 180 days, along with a final listing of all settled appeals and how the payment was priced.

Participation in the LVA program is voluntary so you must choose to continue in the appeals process and wait and hope you win your appeal, or receive a relatively quick one-time payment.

REIMBURSEMENT PAGE

PHOTO: Getty Images

To help you evaluate the LVA program and determine whether you should participate, here are four things to think about: 1. Since the LVA program is voluntary, you may leave the settlement process at any time and continue with the normal appeals process, even if you have submitted an EOI or have received a copy of all of your approved appeals, up to the point of you signing and submitting the administrative agreement. Once you submit the signed administrative agreement, you are bound to the results of the LVA and don’t have any further appeal rights.

2. You don’t have the ability to select which appeals you would like to be subject to the LVA process. You must settle all eligible appeals for each NPI. Thus, you may not choose to settle some eligible appeals and continue to appeal others—it is all or nothing.

3. The lump-sum settlement will be for 62 percent of the net Medicare allowed amount and is calculated per associated claim/appeal and then added together, and it is nonnegotiable. The payment is not guaranteed; if you have any outstanding overpayments, the LVA payment will be used to pay those off.

4. You don’t know what your net settlement amount will be until after you have signed and submitted your administrative agreement. You have the ability to review the final list of eligible appeals and you may use that to make an estimate on the

amount you may receive; however, the final amount determined by CMS and the DME MACs is not known until after the agreement is signed, and at that point you are bound to the LVA process.

Legislative Actions

Investment of resources and administrative actions—including the new LVA initiative—are not the only strategies being taken by HHS to address the backlog of appeals. The third and final action takes the form of proposed legislative reforms that provide additional funding and new authorities to address the volume of appeals.

Three recommendation are outlined in OMHA’s FY 2018 budget: 1. Increase the amount in controversy (AIC), or monetary threshold required to file appeal, to be equal for both the ALJ level and the judicial review level. This would, in essence, increase the AIC for the ALJ. 2. Create/establish a Medicare magistrate system to allow magistrates to hear certain types of appeals requests, to free up the ALJs. 3. In the FY 2017 budget, OMHA requested the establishment of a refundable appeal filing fee per claim per level of appeal.

It is important to understand that none of these examples are pending pieces of legislation; they are merely recommendations made by OMHA. However, in January 2017, CMS did publish a final rule, called, “Medicare

Program: Changes to the Medicare Claims and Entitlement, Medicare Advantage Organization Determination, and Medicare Prescription Drug Coverage Determination Appeals Procedures,” which took some legislative steps to address the backlog of appeals.

The rule allows certain decisions made by the Medicare Appeals Council to become precedential for future determinations/redeterminations/ reconsiderations and ALJ hearings: when they “address, resolve, or clarify recurring legal issues, rules, or policies; or decisions that may have broad application or impact, or involve issues of public interest.” The intent of this change is to provide appellants with a consistent set of appeal decisions, which can help determine if an appeal should be filed, and to increase the consistency of the decision making in the appeals process.

The rule also allows OMHA to use attorney adjudicators to help reduce the ALJs’ workload. The attorney adjudicators will handle items or requests that don’t require a “formal” hearing by an ALJ. This will allow ALJs to focus on conducting hearings and reducing the appeals backlog.

This month’s Reimbursement Page included highlights of some of the steps being taken to reduce the appeals backlog, as well as a description of the new LVA program. For more information about the LVA program, including how the settlement would affect any interest owed or collected, or where and how to submit an EOI form, visit the CMS website at http://go.cms.gov/LVA .

Devon Bernard is AOPA’s assistant director of coding and reimbursement services, education, and programming. Reach him at dbernard@AOPAnet.org.

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O&P ALMANAC | FEBRUARY 2018

21

This Just In

OIG Targets Off-the-Shelf Orthoses The 2018 Work Plan will investigate high utilization and improper payment rates for codes L0648, L0650, and L1833

L0648

L0650

L1833

A

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that, since 2014, claims for the three OTS codes have grown by 97 percent, with allowed charges rising to $349 million in 2016. OIG plans to explore questionable billing practices for these three codes, including the lack of medical necessity documentation from referring providers and instances where no patient/physician encounter occurred within the 12 months prior to provision of the orthosis.

Based on Medicare utilization data from 2014 until 2016, AOPA has determined that less than 10 percent of the OTS devices described by L0648, L0650, and L1833 were provided by traditional O&P companies. The vast majority of these devices—more than 65 percent—were provided by durable medical equipment (DME) suppliers

PHOTO: Getty Images/DNY59

S PART OF AN update to its 2018 Work Plan, the U.S. Department of Health and Human Services Office of Inspector General (OIG) announced that, based on abnormally high utilization and unusually high improper payment rates, two off-the-shelf (OTS) Health-Care Common Procedure Coding System (HCPCS) codes that describe lumbosacral orthoses (L0648 and L0650) and one OTS knee orthosis code (L1833) will be added as an area of focus for investigation

by OIG. All three codes are part of the split code set created by CMS in 2014 that differentiates OTS orthoses from those that require the expertise of a certified orthotist or an equivalently trained professional.

In its announcement, OIG reported

This Just In

without certified O&P professionals on staff. The graphs show the overall utilization of each code by O&P providers, DME providers, and physicians.

While traditional O&P providers represent a small percentage of the overall utilization of these three codes, O&P practitioners should make sure that, when providing OTS orthoses described by these codes and any other codes, proper medical necessity documentation is maintained by the ordering physician and all Medicare policy requirements have been met.

While L0648, L0650, and L1833 have not previously been identified as approved for review by the recovery audit contractor (RAC), the outcome of the OIG review could lead to additional audit activity by the RAC and other contractors.

It will be interesting to see how this issue, identified by OIG as a risk area, fits into the new prepayment audit strategy implemented by the durable medical equipment Medicare administrative contractors (DME MACs) late last year. The Target, Probe, and Educate (TPE) audit program is designed to focus on high utilization HCPCS codes, high claim error rates, and high utilization providers. The OIG identification of these three codes as having a significant increase in utilization, combined with the majority of services being provided by a single provider type (DME), seems to set the stage for the use of the TPE program to focus audits where the problem lies.

(For more information on the TPE program, see Reimbursement Page on page 20).

AOPA will be following this issue closely to determine if OIG will ultimately expand its review into other OTS orthotic services or if it will focus solely on the three HCPCS codes identified. While these three codes represent a very small number of services provided by traditional O&P providers, the results of the OIG review may have a significant impact on the O&P community if it is expanded into other areas.

The OIG Work Plan is available online at https://oig.hhs.gov/.

Off-the-Shelf Lumbosacral Orthosis, L0648 $50,000,000 $45,000,000 $40,000,000 $35,000,000 $30,000,000 $25,000,000 $20,000,000 $15,000,000 $10,000,000 $5,000,000 $

O&P

2014 Allowed Charges

DME

Physicians

2015 Allowed Charges

2016 Allowed Charges

Off-the-Shelf Lumbosacral Orthosis, L0650 $140,000,000 $120,000,000 $100,000,000 $80,000,000 $60,000,000 $40,000,000 $20,000,000 $

O&P

2014 Allowed Charges

Physicians

DME 2015 Allowed Charges

2016 Allowed Charges

Off-the-Shelf Knee Orthosis, L1833 $100,000,000 $90,000,000 $80,000,000 $70,000,000 $60,000,000 $50,000,000 $40,000,000 $30,000,000 $20,000,000 $10,000,000 $

O&P

2014 Allowed Charges

DME

Physicians

2015 Allowed Charges

2016 Allowed Charges

O&P ALMANAC | FEBRUARY 2018

23

COVER STORY

At the

Summit

Four U.S. Paralympic athletes—and their clinicians—finalize preparations to compete in the mountains of South Korea

By LIA K. DANGELICO

NEED TO KNOW

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Nearly 700 athletes will compete in the 2018 Paralympic Games March 9-18 in PyeongChang, South Korea.

Many of the competitors benefit from O&P intervention, including Stephani Victor, Josh Pauls, Andrew Kurka, and Nicole Roundy.

Clinicians should work closely with elite athletes and incorporate their suggestions, such as feedback on successes and failures with previous mechanical designs, into componentry decisions to achieve maximum comfort and function.

Competitors sometimes challenge prosthetists to stretch out of their comfort zone and create unique componentry to help patients achieve very specific goals during competition—such as the monoski Victor asked her prosthetist to build.

Competing in the Games requires an enormous amount of discipline and training, as well as appropriate componentry. Prosthetic devices designed with intimate fit—for ultimate control and proprioception— as well as reliable suspension can help amputee athletes achieve their goals.

Even those athletes who compete without their prostheses—such as Pauls, who is captain of the U.S. sled hockey team—benefit from carefully designed prostheses that aid in their training and conditioning.

Competing in front of a world stage offers competitors the chance to set an example for other individuals with disabilities, and to show others what is possible—whether or not they come home with medals.

FEBRUARY 2018 | O&P ALMANAC

COVER STORY

M

ANY O&P PATIENTS

have found their way to the world of adaptive sports, smashing records and expectations in a variety of athletic endeavors. A special few have risen to the highest levels of athleticism—enduring rigorous training, demonstrating unrelenting dedication, and working with O&P clinicians in seeking best-inclass componentry to achieve their goals. These elite individuals have climbed to the very tip-top of the competition, for a shot at facing off on the world’s stage.

Nearly 700 such athletes will gather for the 2018 Paralympic Winter Games, held March 9-18 in PyeongChang, located in the Gangwon Province of South Korea. Despite being the smallest city to host the Games since 1994, PyeongChang boasts a 24 percent increase in athletes from the Sochi Games in 2014 and a 44 percent increase in the number of female athletes, according to the International Paralympic Committee. From para ice hockey to biathlon to skiing, the Games will feature 80 medal events held at venues across the city.

While watching the Paralympic Games next month, keep an eye out for Pauls on the U.S. hockey team, Victor and Kurka in the sitting ski events, and Roundy in the snowboard competitions.

LOCATION: South Korea’s Gangwon Province, PyeongChang POPULATION:

43,666

WINTER CLIMATE: Long and snowy winters, with Siberian cold air masses passing through the Korean peninsula, causing extremely cold conditions

WHAT IT’S KNOWN FOR: Mountain vegetables and Hanwoo beef (similar to Wagyu beef); Odaesan National Park, which features trails that cross the Taebaek Mountains; and many Buddhist temples

O&P Almanac caught up with four American athletes who are set or hopeful to compete in PyeongChang— Stephani Victor, Josh Pauls, Andrew Kurka, and Nicole Roundy—as well as their clinicians, to learn about the preparation, collaboration, and determination it takes to compete against the best Paralympic athletes the world has to offer.

Attitude Matters

To compete at the Paralympic level requires an enormous amount of motivation, discipline, and training.

The specifics, of course, differ by sport and by athlete. For some, such as alpine skier Stephani Victor, participating in the Games is the culmination of years of determination. “The four years of training for each Paralympics event is structured around a progression that builds to a climax for giving one’s best performance at the actual Paralympic Games,” she says. “World Cup racing is an annual international series of races on a circuit, where you will often be competing with similar elite-level athletes, who will be at the Paralympics.

World Cup competitions require annual progression of preseason, in-season, and postseason training to ramp up for the progression of the circuit.”

SLOGAN:

“Happy 700 PyeongChang,” which hints at the city’s average elevation of approximately 700 meters, or 2,300 feet

HOW TO WATCH: NBC Olympics will present 94 hours of Paralympic television coverage via NBC, NBCSN, Olympic Channel, NBCSports.com, and the NBC Sports app HELPFUL APPS: In addition to the NBC Sports app, download the Team USA app and the PyeongChang 2018 official app

PYEONGCHANG AT A GLANCE O&P ALMANAC | FEBRUARY 2018

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COVER STORY

Stephani Victor

FAST FACTS:

Stephani Victor AGE: 48 HOMETOWN: Park City, Utah EVENT: Alpine skiing CLASSIFICATION: LW12-2, Sitting CLINICIAN: Wendy Glissmeyer,

CPO, clinic manager, Hanger Clinic

TWITTER: @stephanivictor A HANGER CLINIC PATIENT PRIOR PARALYMPIC ACHIEVEMENTS: Two Gold medals,

two Silver, and one Bronze

WHAT IT MEANS TO COMPETE IN THE GAMES: “After experiencing

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teammates compete for a whole season so their efforts revolve around staying sharp all season long. “We all want to be successful … and the team atmosphere allows you to have guys to back you up, push you. There’s also the challenge of relying on and trusting others.”

Pauls is a natural competitor, who has had a passion for hockey since boyhood. Born without tibia bones, he had both legs amputated when he was 10 months old—but that didn’t stop him from dreaming of being the first NHL goalie without legs. Over the years, he has steadily worked to improve his game and, today, he is a two-time Paralympic Gold medalist. In sled hockey, he and his teammates compete without their prostheses, which levels out the playing field, he says. On the ice, “we’re all even, whether we can stand or are in wheelchairs.”

Second-time Paralympic athlete and alpine skier Andrew Kurka shares Pauls’ all-day-every-day approach to preparing for the Games. “Training for the Paralympics is training to be the best in the world,” he says. “It’s a mindset of a 24-hour athlete. Every little thing is a conscious decision … physically, personally, all of the above.

How can I be better? Will this make me better? Am I being the best that I can be to prepare myself for that ever-so-important moment? It’s a huge and constant learning experience.”

PHOTOS: Courtesy Stephani Victor

the devastating loss of losing my legs and meeting and falling in love with my Swiss coach, who helped me re-create my life as an alpine ski racer, to actually race for him, for his country, for his team, and possibly win Gold has been my singular focus since we decided to come back. We are grateful for this opportunity and new experience and, just like the previous Games, we have no idea what the outcome will be.

We only know we are committed to giving our very best.”

Like many Paralympic athletes, Victor’s path to international athletic competition was an unexpected one.

In 1995, an out-of-control car struck her as she stood in her driveway.

Following the accident, she was in critical condition and had to have both legs amputated. Despite a long recovery, which included 14 reconstructive surgeries, she took her first adaptive skiing lesson just three years later.

Victor has her brother to thank for introducing her to the sport. “When I was on life support in the hospital, immediately following my accident, one of the first things my brother—an avid back country skier—said to me was, ‘You can do adaptive skiing,’” says Victor. She admits she’d never heard of it, but in that moment, “a seed was planted,” which later bloomed to bring her the two great loves of her life: skiing and her then-coach, now-husband, Marcel Kuonen. Victor went on to compete in her very first Paralympic Games in 2002 and, to date, has won two Gold medals, two Silver medals, and one Bronze medal for Team USA. This year, to honor Kuonen, who is Swiss, she will be competing under Switzerland’s flag.

For Josh Pauls, captain of the Team USA sled hockey team, gearing up for the Games looks a lot like it does for other competitions. He and his

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COVER STORY

Kurka, too, was a primed competitor from an early age. He showed great promise in wrestling until an ATV accident at age 13 severely damaged three vertebrae in the middle of his spinal cord. He worked hard through his rehabilitation and was fitted with his first pair of lower-limb orthoses when he was 15 years old; today, he uses braces and crutches to stay mobile. He never let his disability become a limitation; Kurka made his first attempt at a monoski as a teenager—and hasn’t ever looked back.

A Prosthetist on the Team

Undoubtedly, these athletes put in the late nights and long hours it takes to glimpse success. But it would be difficult for them to get where they want to go without the help of a dynamic, engaged care team, including an experienced O&P clinician, who understands how preparing an elite athlete differs from “the average patient.”

“In many ways, fitting an elite athlete is similar to fitting a very active patient,” says Pauls’ prosthetist, Fred

Schaumburg, CP, national upperlimb specialist for Hanger Clinic.

“However, for the elite athlete, the prosthetic fit needs to be very intimate Fred Schaumburg, CP for the ultimate control and proprioception, and the suspension needs to be absolutely reliable. Often, auxiliary suspensions are required as extra insurance,” he

A Custom Monoski: Fit for a Champion

Stephani Victor and Wendy Glissmeyer, CPO

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FEBRUARY 2018 | O&P ALMANAC

shape, so that the seat was laminated in the shape she was already accustomed to. I sculpted in plaster and applied carved foam pieces to the mold to create a unique design shape, inspired by listening to Stephani and Marcel talk about their previous mechanical challenges in design. We were looking for something less bulky and angular than most monoski front shell designs.

I laminated the final shape with acrylic and carbon fiber.

“My technicians and I worked outside of regular business hours— long nights and early mornings—and got the project fabricated in about 12 days from start to finish, with the Thanksgiving holiday thrown in the middle. It was a whirlwind, with moments where I wasn’t sure it would work out, and I worried I would have to start over. When complete, Stephani and Marcel were excited to try it out. It passed the test on the slopes, and I was equally satisfied and relieved that we accomplished this feat together.”

PHOTOS: Hanger Clinic

In preparation for the 2018 Games, Wendy Glissmeyer, CPO, clinic manager for Hanger Clinic, worked with her patient and Paralympic athlete Stephani Victor to build a custom monoski to optimize Victor’s chances of winning in PyeongChang.

Below, Glissmeyer details the process of customizing the device.

“I had been fitting Stephani with her prosthetic legs for about two years when, in November 2017, Stephani’s coach and husband, Marcel Kuonen, phoned me from Switzerland and asked me if I could put a little carbon on the seat of the monoski when they returned home to Park City, Utah.

He said, ‘If it could look as lovely as her sockets, she would have the best looking monoski on the mountain!’ I

laughed and told him … I’d see what I could do, although it was nothing I’d ever done before.

“I had intended to help them find a monoski ‘specialist,’ and quickly found out there is no such thing. I decided to take on the project full force because I love working with Stephani, and who wouldn’t want to have a hand in helping someone win a Paralympic medal? Our in-person discussion and disassembly of the monoski quickly morphed into a conversation about how we also needed to reshape and redesign the whole front cover, as Stephani was catching the ski gates on an undercut in front of the seat, which led to increased likelihood of a ski gate making her crash.

“First, we removed and discarded her old front cover, which was heavy and bulky. I casted the monoski metal frame with plaster to capture all the unique shapes and curves. Marcel sanded down her previous fiberglass seat to a thin shell to use as a basic

COVER STORY

says. “For instance, on a transfemoral patient, the primary suspension might be suction, but including a power belt as an auxiliary suspension system helps to ensure that the prosthesis remains attached during high-stress activities such as running. The prosthetic alignment also is a critical factor to achieving maximum function for an elite athlete. High-stress activities, such as running, exaggerate any imperfections in prosthetic alignment.”

For day-to-day life, Schaumburg has helped to ensure Pauls’ devices provide both comfort and function so that he is more confident on his prostheses and doesn’t rely on his wheelchair.

“Basically, my role in helping Josh prepare for the Games is ensuring that his prostheses are functioning optimally,” he says. “While he does not use the prostheses during competition, he heavily relies on them during physical training. He utilizes the limbs while working out and to ambulate to and from the venues. Josh currently has a full-time job and has to train while he is not working. This means that not only does he wear and use his prostheses all day for work, but also needs to rely on them to be comfortable and function properly when he is working out before and after work hours.”

Listening and communication skills are key. “To best meet the specific requirements of any patient, you need to establish a rapport that encourages your patients to communicate openly,” says Schaumburg. “You need to make patients realize that they are as important, if not more important, than

you in the process of fabricating and maintaining their prosthesis. People that take an active role in the process— and communicate what is working well and what can be improved—are the ones that achieve maximum comfort and prosthetic function.”

Kurka similarly has enjoyed a close relationship with his orthotist, Steve Foy, CPO, founder of Northern Orthopedics. Like a true Alaska native, Kurka is an avid outdoorsman, so his gear must be able to keep up with his frequent fishing, hiking, and rock climbing trips, in addition to his skiing.

Kurka and Foy have worked closely together over the past 10 years, and have seen an evolution in orthotic technology, especially in terms of durability.

Kurka recalls that he broke his first set of braces in the first week of use, “then it took a month, and now they’re lasting nearly a year.” Working with Foy, in conjunction with “the development of adaptive equipment, has definitely molded my life and career path,” he says. “It’s an ever-changing world in adaptive sports because people are constantly developing and looking for the next best and faster thing out there.

If it wasn’t for the adaptability and use of my leg braces, I wouldn’t be able to do what I do now. They’ve helped me to realize my true potential.”

FAST FACTS: Josh Pauls AGE: 25 HOMETOWN:

Green Brook, New Jersey EVENT: Hockey PROSTHETIST: Fred Schaumburg, CP, national upper-limb specialist, Hanger Clinic TWITTER: @spudsusa27 A HANGER CLINIC PATIENT PRIOR PARALYMPIC ACHIEVEMENTS: Two Gold medals WHAT IT MEANS TO COMPETE IN THE GAMES: “This will be my third

Games, but it never gets less exciting. It is always an honor to represent your country not only on the ice, but off the ice, too, and be able to interact with other countries.”

PHOTOS: Courtesy of USA Hockey

Josh Pauls

O&P ALMANAC | FEBRUARY 2018

29

COVER STORY

PHOTO: Courtesy of Andrew Kurka

Andrew Kurka

FAST FACTS:

Andrew Kurka AGE: 26 HOMETOWN: Palmer, Alaska EVENTS: Downhill, slalom, giant slalom, super­G, super combined CLASSIFICATION: LW12­1, Sitting ORTHOTIST: Steve Foy, CPO, Northern Orthopedics TWITTER: @Andrew_Kurka PRIOR PARALYMPIC ACHIEVEMENTS: Competed in

2014 Sochi Games

WHAT IT MEANS TO COMPETE IN THE GAMES: “Competing in

PyeongChang, for me, means a chance at greatness—a chance for a legacy and a chance to make a difference.”

PHOTOS: Courtesy of Andrew Kurka

30

FEBRUARY 2018 | O&P ALMANAC

give me a great advantage in Like Pauls and Kurka, skiing. If I were so perfectly Victor has worked with her fitted into my seat, like a ski clinician, Wendy Glissmeyer, boot for a standing skier, I could CPO, a clinic manager for directly translate the pressure Hanger Clinic, for several to the edge of my ski. We are years. They agree that so pleased with the fit and the listening is essential to their design of my monoski seat; I unique bond, and they have Wendy Glissmeyer, CPO have much greater control of built a working relationship translating my movements to the on open communication, trust, performance of the alpine ski.” and a bit of imagination. Case in point: The experience has helped Last year, Victor asked Glissmeyer to build a custom monoski for her to use in Glissmeyer grow as a clinician. “It is the upcoming Games. While Glissmeyer thrilling and equally challenging to work on something that is so far out had no prior experience crafting of the norm for me, but it’s been a monoskis, she took on the challenge rewarding process that’s ultimately and worked tirelessly to build a finished improved my skills as a prosthetist,” product—in a matter of weeks. (Read she says. “Stephani’s equipment is an the sidebar, “A Custom Monoski: Fit extension of her physical body and she for a Champion,” to learn more about must feel one with it, and this can have Glissmeyer’s process.) a direct impact on her performance.”

“Wendy inspires me to take chances and to try new things,” says Victor. “She creates a safe space for me to share any Finding the Right Fit and all of my feelings where I know Well-fitting and advanced prosthetic I will be listened to and deeply cared componentry fit by an experienced for. She works incredibly hard with clinician also is essential for competithe same intensity I bring to my sport.” tors in the latest addition to the Winter Victor says she has been inspired by Paralympic Games—the snowboarding Glissmeyer’s willingness to build her events. Second-time Paralympic snowmonoski. “After working with Wendy boarder Nicole Roundy believes that and gaining success on the fit of my steeper competition requires a more prosthetic sockets, we started playing sophisticated device. And she has been around with the idea, what if I could pushing the limits and expectations of become ‘one’ with my monoski seat, like that competition, as well as her sport, with prosthetic sockets? This would since the very beginning.

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COVER STORY

FAST FACTS:

Nicole Roundy HOMETOWN: Salt Lake City, Utah EVENTS: Snowboard cross, banked

slalom

CLASSIFICATION: SB-LL1 PROSTHETIST: Peter Harsch, CP, co-founder and president of Peter Harsch Prosthetics TWITTER: @NicoleRoundy AN ÖSSUR ATHLETE PRIOR PARALYMPIC ACHIEVEMENTS: Competed in

2014 Sochi Games

WHAT IT MEANS TO COMPETE IN THE GAMES: “It’s an opportunity

to represent my country at the best that I’ve ever been. It’s also a representation of my athletic career. I’m a completely transformed a person from who I was a decade ago.”

PHOTOS: Natasja Vos Photography

32

FEBRUARY 2018 | O&P ALMANAC

PHOTOS: Courtesy of Össur

AGE: 32

In 2006, Roundy became the very first above-knee amputee athlete to compete in para-snowboarding, more broadly known as adaptive snowboarding. In her eyes, her accomplishments helped drive the demand for better prosthetic knee technology.

She also played an instrumental role in getting adaptive snowboarding onto the Games’ roster, by spearheading an online petition campaign that eventually led Paralympic organizers to recognize the sport.

Para-snowboarding was introduced as a medal event for the first time at the Sochi 2014 Winter Paralympic Games, under the alpine skiing category.

For PyeongChang, with the inclusion of two different snowboarding categories at the Games—snowboard cross and banked slalom—“they really stepped up the qualifications requirement and made it much harder to qualify to earn a spot.

Through the years, the whole sport has become a lot more serious, and that’s helped me become a better athlete as a result,” says Roundy, whose right leg was amputated above the knee at age 8 after a diagnosis of osteogenic sarcoma.

As she’s worked to advance her skills in snowboarding, she’s had to push the limits of her device, too.

“I have to be open to trying new things,” she says. “With my socket suspension, I knew what I wanted but didn’t have the knowledge to make it happen.” Fortunately, her prosthetist, Peter Harsch, CP, of Peter Harsch Prosthetics, “had so much knowledge about the current technologies that we came up with some things that have never been done before, and the end result works really well for me.”

Roundy attributes a big part of her success to having faith in her prosthesis. “Whether it’s training in the gym or on the slopes, I need confidence that my prosthesis will do its job, to ensure it’s ready and I’m ready,” she says. “There is quite a bit of maintenance. I have a close relationship with [Harsch], so while I can do some things on my own, I have to be able to get help when I need it.” For example,

Nicole Roundy while competing recently in the Netherlands, Roundy was having some trouble with her prosthesis. She texted Harsch; he was able to contact a local rep, who showed up with a replacement so her device could be repaired.

Roundy also believes that changes in sports and the scope of competition are advancing O&P technologies.

When she was just starting out, Roundy says prosthetic technology was much less advanced, so to see recent evolutions and availability has been significant. Being able to train and “trust [my] step” is critical, says Roundy. “I no longer feel limited by my prosthesis. When you get to that point, your prosthesis becomes a part of you. It’s no longer a separate entity.

I trust my prosthesis in a way and level that I never expected to. … It works for me to the point I no longer compare it to the leg I lost.”

COVER STORY

Support and Motivation

As the popular adage goes, it takes a village to raise a child—the same can be said for a Paralympic athlete. “I gather motivation from the world around me, every single day,” says Roundy. “It might come from my friends, teammates, an incredible group of coaches, or my sport psychiatrist, who has been an incredible resource for me. She always has the right thing to say at the right moment. When I’m not feeling confident in the middle of the competition, she is the one person I can text anytime, who believes in me and gives me back my confidence.”

Admitting that a Gold medal would be nice, “my personal goal is to focus on my individual growth as an athlete,” says Roundy. “It’s just really small steps forward. In bank slalom, we try to get as high up in the snow [for speed] as possible, and I’m slowly making that line higher and higher. So I’m getting faster and faster, not throwing myself so far out of my comfort zone, but still challenging

myself.” During the board cross event, on the other hand, “it’s about being more dynamic, having more fluid motion with my body,” Roundy says.

“No matter what I compete in, I’m always just trying to get a little bit better, and hoping my best will be at the Games.”

Pauls also gives a lot of credit to his support system. “My friends and family motivate me and push me to be best version of myself, which plays into me pushing myself in sport,” he says. He isn’t concerned with point totals or coming away with more medals; he just hopes to be proud of his performance.

Competing at this level also provides a platform to set an example. “My motivation comes from my ability to help others,” says Kurka. “I feel like it’s a great purpose of mine to be a competitor, to be an example, and to make a difference. I just hope I can … be a positive example that helps others realize their true potential.” While he wouldn’t mind bringing home a few

medals, he hopes “for people to see what the Paralympics are about and to realize they can be a part of it also.”

After the Games, he dreams of opening up a bed-and-breakfast in Alaska, where he can provide fishing tours for people with disabilities.

For Victor, the Games will be an opportunity to achieve both personal and professional goals. “I am committed to giving my best athletic performance at the Paralympic Games in PyeongChang so that I may win a Gold medal … and dedicate the victory to [my husband, Marcel] as a tribute of my gratitude for his dedication to me as coach and serviceman for the last 18 years of ski racing together,” she says.

“I owe every success and everything that I have learned on this journey to him. I am most grateful to share this journey with the person I love and respect the most.”

Lia K. Dangelico is a contributing writer to O&P Almanac magazine.

Reach her at liadangelico@gmail.com.

O&P ALMANAC | FEBRUARY 2018

33

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By CHRISTINE UMBRELL

MAXIMUM RETURNS WHAT THE TAX PROVISIONS IN THE TAX CUTS AND JOBS ACT MEAN FOR O&P PROFESSIONALS

NEED TO KNOW • O&P facilities should be aware of the changes to the tax code resulting from the recently enacted Tax Cuts and Jobs Act, which are expected to result in lower tax rates for many O&P business owners and staff.

• While corporations now face a flat rate of 21 percent, other types of companies—including partnerships, S corporations, and sole proprietors— can claim a deduction equal to 20 percent of their Qualified Business Income. But this deduction does not apply to “service” providers—such as O&P patient-care facilities—if their taxable income exceeds $157,500 for single taxpayers or $315,000 for those married, filing jointly.

• The bonus depreciation rule has been modified to allow a bonus depreciation of 100 percent for both new and used qualifying property, retroactive for property acquired after Sept. 27, 2017, and placed in service before Dec. 31, 2022.

• O&P facilities should work with their tax advisors to explore whether, and to what extent, they may benefit from the research and development credit incentive. Companies that experiment with new technologies, develop new products, or create solutions for customer-specific solutions may qualify.

• The new tax brackets mean lower taxes for many individuals, so paychecks will need to be adjusted accordingly. Employers are required to follow the new withholding tables beginning Feb. 15, 2018.

• The Tax Cuts and Jobs Act also repeals the individual mandate of the Affordable Care Act, which could lead to fewer Americans with health insurance coverage in the coming years.

36

FEBRUARY 2018 | O&P ALMANAC

B

IG CHANGES FOR ALL companies—

including O&P businesses—arrived in mid-December 2017 when the Tax Cuts and Jobs Act was passed

by Congress and signed into law by President Donald Trump. The tax reform bill made major changes to both corporate and individual tax provisions. Among other modifications, the legislation lowered the corporate tax rate and altered credits and deductions, all of which may have a significant impact on O&P companies.

The good news is that almost all businesses can expect tax cuts.

But the law is complicated, with different tax rates for corporations versus different types of businesses, so O&P professionals will need to look closely at all of the provisions to determine exactly how the legislative changes will affect their companies— and their incomes.

Something for Everyone

The new law features a wide array of changes. Some of those alterations include a reduction in tax rates for businesses and individuals; a personal O&P facilities may be interested to tax simplification by increasing the learn that the thresholds for accounting standard deduction and family tax methods have been altered due to the new credits, but eliminating personal laws. More entities will be able to use the exemptions and making it less benecash method of accounting. Under the old law, a corporation or partnership with a ficial to itemize deductions; a limit in corporate partner could only use the cash deductions for state and local income method of accounting if its average gross taxes and property taxes; a limit on the receipts did not exceed $5 million for all mortgage interest deduction; a reducprior years.

With the new laws, the $5 million threshold has increased to tion in the alternative minimum tax for $25 million, and the rule that such businesses satisfy the requirement for individuals (and its elimination for corall prior years has been repealed, according to Greg Will, CPA, MST, CFE, porations); a reduction in the number of Hertzbach Certified Public Accountants. of estates impacted by the estate tax; and repeal of the individual mandate of the Affordable Care Act (ACA).

The premise behind the new law 100 Percent Bonus Depreciation is that it will spur economic growth legislation that could have an impact across the United States by adjusting on their facilities and their incomes.

The Tax Cuts and Jobs Act made the tax structures for small businesses significant modifications to the and corporations, according to the bonus depreciation rule, allowing for Corporate Tax Cut Republican legislators who crafted a bonus depreciation of 100 percent, Corporations stand to gain the most it. “The theory is, with very large tax retroactive for property acquired from the new tax law, according to cuts for businesses and moderate after Sept. 27, 2017, and placed in serWill, due to the decrease of the corcuts for individuals, the legislation porate tax rate from a maximum of 35 vice before Dec. 31, 2022. Deductions will spur businesses to invest more, percent to a flat rate of 21 percent—a that qualify under the new tax become more profitable, and increase reduction, as well as a simplification, codes can be taken “immediately, as wages. But it will take several years of this section of the tax code. opposed to depreciating over time,” to play out,” says Steven Prior to 2018, the explains Rosenthal. Previously, bonus Rosenthal, a senior fellow previous tax rates varied depreciation generally equaled 50 in the Urban-Brookings Tax by taxable income. For percent of the cost of property for the Policy Center. example, corporations with first year it was placed in service, and Overall, smaller O&P taxable income between phased down in subsequent years. facilities and owners will $50,000 and $75,000 were This change allows an immediate benefit from the recent required to pay taxes of 100 percent deduction to be taken changes to the tax laws by $7,500 plus 25 percent of for qualifying property. “Typically, Steven Rosenthal realizing greater after-tax the amount over $50,000; with these types of assets, you would incomes, says Greg Will, CPA, MST, corporations with taxable income have to capitalize and depreciate the CFE, of Hertzbach Certified Public between $100,000 and $335,000 deduction, but now it can be taken Accountants. The idea behind the tax were required to pay $22,250 plus 39 immediately” for qualifying assets, cuts “was to incentivize all compapercent of the amount over $100,000. explains Will. “Qualifying property” is Legislators sought to both simplify defined in Section 168(k)(2) as tangible nies,” he says. The shift to both lower and decrease the tax brackets for property with a recovery period of 20 tax brackets and wider tax brackets corporations. The result is a 21 years or less, and includes such items is expected to “mostly benefit” O&P percent flat tax for all taxable as equipment, furniture and fixtures, companies, he says. “It’s important qualified improvement property, and to know that every person and every income levels. other items. (Consult with a qualified business will see both pros and cons, This cut will likely benefit all tax expert for details.) and every business should be proaccorporations—except those with In addition, bonus depreciation now taxable income of $50,000 or less, tive to make the net effect as positive applies to “used” property purchased which paid a tax rate of just 15 as possible.” by a taxpayer. Property that is “new” to percent previously. But there are O&P business owners and practhe taxpayer—whether new or used— several other changes that will also titioners will benefit from a more qualifies for depreciation. impact corporations. in-depth look at several sections of the

Methods Matter

O&P ALMANAC | FEBRUARY 2018

37

Tax Legislation Allows Repeal of ACA Individual Coverage Mandate One significant provision in the tax reform legislation that may have an impact on O&P professionals—but not on their taxes—is the law’s repeal of the individual mandate in the Affordable Care Act, which requires individuals to have health insurance or face a penalty fee of 2.5 percent of income or $695.

Without the individual mandate, it is believed that some previously insured healthy individuals will opt out of getting health insurance. The Congressional Budget Office estimates that the absence of the mandate will result in an increase of 13 million in the number of uninsured Americans by 2027.

More information on this topic will be published in the March issue of O&P Almanac, in an article focusing on the 2018 health-care climate.

Section 199 Repeal The Tax Cuts and Jobs Act repeals Section 199, the Domestic Production Activities Deduction (DPAD), for corporations for the tax years beginning Greg Will, CPA, MST, CFE after Dec. 31, 2018. The legislation also repeals the DPAD for noncorporate taxpayers after Dec. 31, 2017. Section 199 allows a taxpayer to claim a deduction equal to 9 percent (or 6 percent for certain oil and gas activities) of the lesser of the taxpayer’s taxable or qualified production activities income, subject to a limitation of 50 percent of W-2 wages paid by the taxpayer during the calendar year that are allocable to the taxpayer’s domestic production gross receipts. This deduction has been eliminated.

The loss of this deduction is in keeping with the goal of the overarching intent of the tax reform legislation to lower the tax rates but broaden the base, explains Will. “Overall taxable 38

FEBRUARY 2018 | O&P ALMANAC

income is higher, but it’s taxed at a lower percentage,” he says.”

Cuts for Non-Corporations

For companies that are not corporations, the creation of Section 199A of the new tax code, Deduction for Qualified Business Income (QBI), is the most important—and most complicated—section of the new law.

Under 199A, some taxpayers other than corporations—including partnerships, S corporations, and sole proprietors—can claim a deduction equal to 20 percent of their QBI. However, QBI does not include wage income but rather “business flow-through income,” says Will.

It’s important to note that not all trades and businesses qualify for the 199A deduction. Companies that qualify as “services”—such as health (for example, an O&P patient-care facility), law, accounting, and several other types of “service” firms where the “principal asset of such trade or business is the reputation or skill

of one or more of its employees or owners”—do not qualify if their owners have taxable income of more than $315,000 for those married, filing jointly, or $157,500 for single taxpayers (see the flowchart on page 40). If their taxable income is less than $315,000/$157,500, several other factors, included in the flow chart, will determine whether they are eligible for the deduction. “Some O&P owners will not be eligible if their income is too high since they are in the health industry,” explains Will.

O&P manufacturing companies that are not corporations will likely qualify for the deductions, regardless of taxable income, says Will, because they are manufacturing and not health services companies, according to the law. “The goal [of tax reform] is to incentivize companies that hire other employees,” he explains, “so businesses that pay W-2 wages to employees and are not specified ‘service’ businesses will generally get the full deduction.” O&P companies that offer both patient-care and manufacturing services may be able to take the deduction for the segment of their company that is dedicated to manufacturing, suggests Will.

For patient-care facilities that also handle fabrication, it is unclear whether the 20 percent 199A deduction will be allowed for the segment of facilities that are dedicated to fabrication. Further clarification from the Internal Revenue Service (IRS) may be issued via guidelines that are to be published, says Will. “The hope is that the IRS will recognize and provide a means for businesses to split incomes within one business to get the 20 percent deduction on fabrication,” says Will. But if the issue is not resolved, “some owners may need to split their businesses into two companies,” he explains: a patient-care business that does not qualify for the QBI deduction if income is too high, and a fabrication business that does qualify. Once further guidance is published, more information will become available on whether such a split would be beneficial.

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20 Percent Deduction on Pass-Through Income • Flowchart is based on one pass-through entity; if multiple entities, calculation must be done separately for each.

• Taxable Income is the taxable income from the 1040 before this deduction.

• Qualified Business Income (QBI) = Income and deductions on K-1 not including short-term capital gains, long-term capital gains, interest, or dividends (less any qualified business loss carried forward from previous years).

• Income must be from a trade or business activity.

• MFJ = Married Filing Jointly.

Is taxable income above $315,000 (MFJ) or $157,500 (Other)?

YES

Is it a specified service trade or business* other than architecture or engineering?

NO

Deduction will be the lesser of: 1. 20% of QBI or 2. 20% of (taxable income less net capital gain)

NO

*Specified Service Business—business in the field of

health, law, consulting, athletics, financial services, brokerage services, or any trade of business where the principal asset is the reputation or skill of one or more employees or owners. (Note engineering and architecture are specifically excluded.)

40

FEBRUARY 2018 | O&P ALMANAC

Partial deduction will be allowed subject to both an income phase-out and wage limitation phase-in.

YE

Partial deduction will be allowed based on phased-in wage limitation.

Although there were no direct changes to the research and development (R&D) credit as part of the Tax Cuts and Jobs Act, the value of the credit to taxpayers has been enhanced by the reduction in the corporate tax rate and the repeal of corporate alternative minimum tax (AMT), a limiting factor

YES

S

NO

R&D Credit

No deduction is allowed.

NO

Is taxable income above $415,000 (MFJ) or $207,500 (Other)?

SOURCE: Hertzbach Certified Public Accountants

YES

Is taxable income above $415,000 (MFJ) or $207,500 (Other)??

Wage Limit Applies: Combined Qualified Business Income is the lesser of: 1. 20% of QBI; or 2. The greater of A. 50% of your share of W-2 wages; or B. 25% of your share of W-2 wages + 2.5% of unadjusted basis of qualified property.

Deduction is the lesser of: 1. Combined Business Income calculated above; or 2. 20% of (taxable income less net capital gain).

in some companies’ ability to benefit from the credit, according to Patrick Wallace, managing director in BDO USA’s R&D tax services practice.

Furthermore, “as provided for by the PATH Act of 2015, many non-corporate small businesses will continue to have the opportunity to reduce their taxes by offsetting their shareholder or partner-level AMT with R&D tax credits, and some startup businesses can elect to take up to $250,000 in credits against their portion of payroll taxes (FICA) annually for up to five years,” says Wallace. “This allows companies to monetize credits where they

previously could not due to a lack of federal income tax liability.”

Generally, the R&D credit is available to companies that attempt to develop or improve the functionality, performance, reliability, or quality of a product, process, software, invention, technique, or formula to be held for sale, lease, or license or used in the taxpayer’s business, says Wallace.

In general, manufacturers are the greatest beneficiaries of this credit, according to Will. However, he believes that “the majority of O&P facilities would qualify for the R&D tax credit,” he says. “The definition of R&D is much more inclusive than people realize.”

and to what extent, they “In the O&P industry, can benefit from the R&D this could be, for example, tax credit incentive and/ experimenting with new or if recent law changes technologies or materials, potentially enhance their developing new products, ability to do so. “In my or creating solutions for experience, companies in customer-specific appliPatrick Wallace many industries, including cations,” explains Wallace.

O&P, typically discount To qualify, these attempts many of their activities, considering must involve a process of evaluating them to not be ‘R&D’ and failing to alternatives to eliminate uncertainty understand the breadth of what can regarding the taxpayer’s capability or potentially be eligible for the credit,” methodology to develop or improve he says. “They simply leave money a component, or the component’s on the table with this thinking, design, according to Wallace. “That not realizing that these tax savings process’s success or failure must opportunities are out there to help fundamentally rely on technologfund their continued investments in ical principles—engineering or the these areas.” computer, physical, or biological Between federal and state R&D sciences.” credits, the benefit can oftentimes be Wallace suggests that O&P busibetween five and 20 percent of every ness owners think broadly about dollar of qualified wages, supply their activities and work with their costs, and contractor costs related to tax advisors or specialists in the those activities, says Wallace.

R&D credit field to assess whether,

Ferrier Coupler Options!

New Brackets and Withholding Recommendations O&P professionals at all levels also will want to pay attention to the changes to individual tax provisions. The biggest change in this realm is the percentages attributed to each income bracket.

While the tax laws retain a sevenbracket system, there are lower rates for all taxpayers effective Jan. 1, 2018.

In addition, it’s important to note that the AMT has been retained for individuals (though not for corporations). The exemption amounts for individuals have been increased, the exemption phase-out thresholds are increased, and many of the tax preference items that are AMT addbacks have been suspended, resulting in fewer taxpayers paying AMT, says Will. “Only a small fraction who paid AMT in the past will have to pay it now.”

Given the new tax brackets, the IRS has updated withholding tables for employers. On Jan. 11, 2018, the

Interchange or Disconnect

The Ferrier Coupler provides you with options never before possible:

Enables a complete disconnect immediately below the socket in seconds without the removal of garments. Can be used where only the upper (above the Coupler) or lower (below the Coupler) portion of limb needs to be changed. Also allows for temporary limb replacement. All aluminum couplers are hard coated for enhanced durability. All models are interchangeable.

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The A5 Standard Coupler is for use in all lower limb prostheses. The male and female portions of the coupler bolt to any standard 4-bolt pattern component.

The F5 Coupler with female pyramid receiver is for use in all lower limb prostheses. Male portion of the coupler features a built-in female pyramid receiver. Female portion bolts to any standard 4-bolt pattern component.

The Ferrier Coupler with an inverted pyramid built in. The male portion of the pyramid is built into the male portion of the coupler. Female portion bolts to any 4-bolt pattern component.

Model FA5

Model FF5

Model FP5

NEW! The FA5 coupler with 4-bolt and female pyramid is for use in all lower limb prostheses. Male portion of coupler is standard 4-bolt pattern.

Female portion of coupler accepts a pyramid.

Model T5

NEW! The FF5 has a female pyramid receiver on both male and female portions of the coupler for easy connection to male pyramids.

NEW! The FP5 Coupler is for use in all lower limb prostheses. Male portion of coupler has a pyramid. The Female portion of coupler accepts a pyramid.

The Trowbridge Terra-Round foot mounts directly inside a standard 30mm pylon. The center stem exes in any direction allowing the unit to conform to uneven terrain. It is also useful in the lab when tting the prototype limb.

The unit is waterproof and has a traction base pad.

O&P ALMANAC | FEBRUARY 2018

41

Seven-Bracket System for Individual Taxes Tax Laws Retain a Seven-Bracket System But Lower the Rates for All Taxpayers Effective Jan. 1, 2018 Tax Rate

Married Filing Jointly Single and Surviving Spouses

10 Percent

$0-$19,050 $0-$9,525

12 Percent

$19,051-$77,400 $9,526-$38,700

22 Percent

$77,401-$165,000 $38,701-$82,500

24 Percent

$165,001-$315,000 $82,501-$157,500

32 Percent

$315,001-$400,000 $157,501-$200,000

35 Percent

$400,001-$600,000 $200,001-$500,000

37 Percent

More Than $600,000 More Than $500,000

Source: Hertzbach Certified Public Accountants

IRS released Notice 1036, which updates the income-tax withholding tables for 2018 reflecting changes made by the tax reform legislation.

According to a press release from the IRS, “Many employees will begin to see increases in their paychecks to reflect the new law in February. The time it will take for employees to see the changes in their paychecks will vary depending on how quickly the new tables are implemented by their

employers and how often they are paid—generally weekly, biweekly, or monthly.” Employers are required to follow the new withholding tables beginning Feb. 15, 2018.

The revised withholding tables are designed to work with the Forms W-4 that workers have already filed with their employers to claim withholding allowances, according to the IRS. But the IRS also is working on revising the Form W-4 to reflect additional

modifications in the new law, such as changes in available itemized deductions, increases to the child tax credit, the new dependent credit, and repeal of dependent exemptions. The updated Form W-4 should become available within the next couple of months, according to Will. Business owners should make the appropriate withholding changes as soon as possible and should “consult with their CPA or tax attorney” to ensure they remain in compliance.

The Bigger Picture

The Tax Cuts and Jobs Act has made significant changes that will affect all taxpayers. “The tax rates are dropping pretty substantially,” says Rosenthal.

He advises O&P business owners and managers to consult tax advisors to determine how they can best take advantage of the lower business taxes— while they last. While most of the corporate tax provisions are permanent, the individual tax provisions are set to expire on Dec. 31, 2025. “It will be a challenge for those tax cuts to be extended past 2025,” he predicts.

Will also suggests planning for the Dec. 31, 2025, sunset of most non-corporation provisions—but “don’t assume that the law will remain static” between now and then, he says. “Do not jump the gun or make drastic changes,” he advises.

O&P professionals who study the new laws and consult with tax advisors could stand to benefit from tax reform. Education is key to making the most of tax laws and retaining income to invest back in businesses or in employees.

Christine Umbrell is a contributing writer and editorial/production associate for O&P Almanac. Reach her at cumbrell@contentcommunicators.com.

EDITOR’S NOTE: This material is not intended, and should not be relied on, as legal advice.

AOPA members should consult with their own CPAs and counsel about their 2018 taxes.

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FEBRUARY 2018 | O&P ALMANAC

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PRINCIPAL INVESTIGATOR

Prepping for Industry 4.0 Researcher Silvia Raschke, PhD, embraces new technologies to take O&P to the next level

S

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FEBRUARY 2018 | O&P ALMANAC

Early Entry Into Research

Raschke’s early work at BCIT sparked her interest in O&P research almost three decades ago. “I had just started at BCIT as an orthotics instructor and was asked to take on a project funded by the Science Council of British Columbia at the University of British Columbia Medical Engineering Research Unit to explore the use of CAD/CAM in the production of spinal orthoses,” she recalls. “This was a good match as I had done a few years of computer science studies at university before starting my education in prosthetics and orthotics.” The principal investigator at the time was Carl Saunders, who later went on to found Vorum Research Corp.; Raschke collaborated on several other projects with Saunders prior to completing her doctorate.

Since then, she has built an impressive resumé of O&P-related research projects.

One of the most groundbreaking studies Raschke has been involved in was her work on prosthetic foot design and socket design about five years ago, which “has the potential to benefit all amputees by providing objective evaluation of components,” she says. For this project, her team identified a belief among both clinical peers such as therapists and physicians, as well as insurers, that the prosthetist is biased when making prescription recommendations, “with some study participants also indicating they believed the amputees to be biased in favor of more expensive/exotic components by social media and advertising.” Her team decided to test this belief, “which caused quite a bit of commotion among the

PHOTO: Silvia Raschke, PhD

ILVIA RASCHKE, PhD, has played many roles in the O&P profession throughout her career, with none more important than researcher. In a challenging health-care climate, she looks to a simple, but wise, expression to explain her perspective on the future of the profession: “The secret to change is to focus all of your energy, not on fighting the old, but on building the new.”

Raschke has spent many years “building the new,” by devoting time and effort into countless research initiatives— including as an author of more than 30 O&P-related publications and a presenter of more than 40 papers—and has held the roles of clinician and instructor.

She currently serves as project leader in the MAKE+ department at the British Columbia Institute of Technology (BCIT), which she has been affiliated with for 28 years, and is principal investigator at the Centre for Rehabilitation Engineering and Technology That Enables (CREATE) in Burnaby, British Columbia, Canada.

MAKE+ specializes in user-based design, Silvia Raschke, PhD (far right), works with Toshi which engages the Kobayashi, PhD; Michael Orendurff, PhD; Jaimie users of technology Borisoff, PhD; David Moe; and Johanne Mattie with the goal of produring the first prosthetic component evaluation ducing products and project funded by WorkSafeBC, which laid the solutions that create groundwork for the AOPA-funded foot study economic value and/or several years ago improve quality of life.

For 2018, O&P Almanac is introducing individuals who have undertaken O&P-focused research projects.

Here, you will get to know colleagues and health-care professionals who have carried out studies and gathered quantitative and/or qualitative data related to orthotics and prosthetics, and find out what it takes to become an O&P researcher.

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PRINCIPAL INVESTIGATOR

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FEBRUARY 2018 | O&P ALMANAC

PHOTO: Silvia Raschke, PhD

conventional component, “as prosthetists and O&P faculty assothe team kept considering why ciated with the project,” she recalls. it is designed the way it is and “The result was the double-blind how it could likely be re-designed model used in the AOPA-funded foot to be stronger and more effecstudy, which, interestingly, showed tive—especially when paired that not only were there biomechanwith 3-D-printed sockets.” ical differences between foot designs, This project series also has but that, on certain dimensions, these supported “what will likely be recdifferences were discernable by the ommendations to be considered in amputees, who were also double the next evolution of testing stanblinded.” The findings offered results dards for sockets,” she says. “We “that not only gave voice to the end continue to test sockets and are user but also provided evidence that beginning to add a parallel project Raschke (far right) with Yvette Jones, PhD, contradicted the commonly held bias stream adding Finite Element and a study participant during a component of therapists, doctors, and insurers Analysis and how this may play a evaluation project that prosthetists and amputees are role in generating novel prosthetic biased in their component choices.” socket designs—completely difOver the years, Raschke has noted a supporting some form of economic ferent from how any sockets are currently growing interest in O&P research. She benefit, either with a successful product being shaped, and which may address points to the Great Recession as a turning to market, cost-saving measures, some of the unaddressed needs that point for health care in particular and or objective evidence to support have long been identified by amputees.”

O&P specifically, resulting in a climate communication with payors.”

In addition to her work in prosthetics that is leaner and more evidenceWhile the work of Raschke and her research, Raschke has collaborated based. This pivot to research and team—which can involve multiple closely with Wiivv Wearables in the outcomes has led to innovation and members within her department and, evolution of 3-D-printed foot orthotics. creativity, particularly among the at times, collaboration with industry They have just completed “the two engineering students and young entrepartners—sometimes results in peermost successful rounds of funding for preneurs with whom Raschke works. reviewed publications, the team often a 3-D-printing startup to date, holding “I think the 3-D-printing prosthetics draws on the literature and considers the record for most funded 3-D-printed movement is a good example of this,” how their research can be applied to product on Kickstarter,” she says. Wiivv she says. “While many of the initiatives O&P design or practice “in a real way that has teamed with Raschke as well as with founded with the objective of revolutioncontributes … to better business models.” a biomechanics research group assoizing prosthetics did not end up doing so For example, Raschke’s team is ciated with training and rehabilitation as explosively as media hype promised, involved in a lengthy collaboration on of elite athletes in developing a novel these media reports created a profound a series of student projects in partnerapproach to providing 3-D-printed shift in how prosthetic limbs are seen ship with Barber Prosthetics. They are comfort foot orthotics and is developing cosmetically and what the supply chain studying the safety and liability concerns a product line that is “grounded in of the future could look like.” She points associated with providing 3-D-printed objective science but that directly meets to “an emergent tech-savvy culture sockets to amputees as part of their expectations of customers.” The new that is culturally diverse and not afraid definitive prosthetic device. “Using the concept has resulted in an e-commerce to reach out to the end user directly via most appropriate ISO standard we could model for customized foot orthoses. social media at the same time that new identify (ISO 10328), we tested a series Raschke’s work with Wiivv is an business models are available, and data of different materials and print paramexample of her foray into Industry 4.0, a has become ubiquitous. What is starting eters, with some unexpected results,” name for the current trend of automation to germinate is very cool indeed.”

Raschke says. “We observed pylons and data exchange in manufacturing bending before the 3-D-printed socket technologies. “I think that the primary Exploring Innovative Solutions was breaking. We saw breakage of beneficiaries will be millennials and the At BCIT, Raschke is currently engaged sockets, both traditionally made and generations who follow. These younger in research that relates to the design 3-D printed, where conventional generations will drive change in O&P, of O&P components, in part where the wisdom—empirical observations— as well as all similar sectors, because production of the components may or predicted they would break, supporting they have comfort with and desire for may not be supported by 3-D-printing the value of the knowledge prosthetists web-based business models; higher production. “We tend to work at the and prosthetic technicians have based and more vocal expectations; easy midpoint of the innovation pipeline, on their daily practice.” Her team also access to ubiquitous technology and with a focus on an ideal endpoint of identified the potential to redesign a willingness to create their own solutions;

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PRINCIPAL INVESTIGATOR

and a completely different mind frame regarding diversity and body images and concepts around the prosthesis as self-expression,” according to Raschke.

“The change also will be facilitated by economic pressures from payors who will adopt all change that drives down costs, irrespective of which provider that ‘solution’ comes from—so long as the change does not create an organized outcry from end users or their advocates—something that will increasingly play out on social media as opposed to via organized lobbying.”

Emphasizing the Importance of Data Collection

Almost all of the O&P projects Raschke is currently involved in focus on user needs where the user is defined as either the amputee/ orthosis user or, in some projects, the O&P clinician. “Our research teams seek to support the development of objective, evidence-based clinical and manufacturing practices from one or both of these user perspectives.

“Sometimes this is in the form of answering a specific question or solving a specific problem identified by either group. Other times it is done at a systemic level, where we look to connect new

”… I believe there will be quite a bit of interesting work that will be done that focuses on the ‘patient’ as end user.”

–SILVIA RASCHKE, PhD

approaches, knowledge, or thinking to one or both to influence change and give direction to the overall assistive device provision process, from prescription to fitting and follow up,” Raschke explains.

With this approach, Raschke’s team seeks to empower clinicians to optimize their clinical, production, and business practices with the use of data, outcomes measures, and evidence-based practices and processes “in an objective manner that should put to rest any suspicions, on the part of payors, that O&P clinicians are biased in their practices, as well as perceptions that patients themselves are biased,” she says. She points to her work with Barber Prosthetics as an

Notable Works

Among the dozens of O&P-focused published works and presentations Silvia Raschke, PhD, has been involved in, three stand out: • Orendurff MS, Raschke SU, Winder L, Moe D, Boone DA, Kobayashi T. “Functional Level Assessment of Individuals With Transtibial Limb Loss: Evaluation in the Clinical Setting Versus Objective, Community Ambulatory Activity.” Journal of Rehabilitation and Assistive Technologies Engineering, 3(1-6), March 2016.

• Highsmith MJ, et al. “Economic Evaluations of Interventions for Transtibial Amputees: A Scoping Review of Comparative Studies.” Technology and Innovation, Vol 18, pp. 85-98, 2016.

• Raschke SU, Orendurff MS, Mattie JL, Kenyon DE, Jones OY, Moe D, Winder L, Wong AS, Moreno-Hernández A, Highsmith MJ, J Sanderson D, Kobayashi T. “Biomechanical Characteristics, Patient Preference, and Activity Level With Different Prosthetic Feet: A Randomized Double-Blind Trial With Laboratory and Community Testing.” Journal of Biomechanics, 48(1), 2015.

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FEBRUARY 2018 | O&P ALMANAC

example of how her initial partnership with a facility on an outcome measures project led to the owner becoming more involved in research—he has now, independently, “built up a robust in-house research model and commitment to innovation and quality improvement, and [is] engaging in projects with numerous postsecondary institutions.”

Eye on End Users

Raschke and her team are currently experimenting with a “Make-athon” model in conjunction with a collaborating institution, the Munich Center for Technology in Society, as a way of engaging with amputees to identify their priorities and begin to generate solutions in interdisciplinary teams. “Initial forays into this model have been successful and help, in an objective manner, to give a documented voice to the amputees who, we are hearing, are grateful for what is being done ‘for them’ but see room for considerable innovation in prosthetic technology,” says Raschke. “As Industry 4.0 and the Internet of Things begin their transformation from buzzwords to innovation that fits within a profitable business model, I believe there will be quite a bit of interesting work that will be done that focuses on the ‘patient’ as end user” and results in more end-user involvement in final devices.

Raschke plans to continue supporting work relating to mass customization, identifying and addressing the unfiltered needs of amputees, testing O&P designs, and exploring the intersection of Industry 4.0 with new business models—“all of which will impact the practice of O&P in coming years,” she says.

She expects the evolution to be steady yet gradual. “The change will happen more like slowly rising water, where some people will respond by building moats and try to stem the tide, hoping they won’t drown. Others will respond by building a boat and thinking of how to capitalize on all that water.”

Ultimately, the researcher in Raschke is a true believer that the future will be shaped by those who can identify and provide solutions that meet user needs, and can do so within a realistic business model.

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Daniel Kirk of Australia competes in the Men’s Discus Throw F44 Final during day three of the IPC World ParaAthletics Championships 2017 at the London Stadium on July 16, 2017 in London, England.

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MEMBER SPOTLIGHT

Kinetic Prosthetics

By DEBORAH CONN

Physical Education Pennsylvania facility encourages patient mobility via activity

K

INETIC PROSTHETICS, LOCATED IN West Chester,

50

FEBRUARY 2018 | O&P ALMANAC

Kinetic Prosthetics clinicians encourage patients such as Hunter (left) and Allie to engage in physical activities.

FACILITY: Kinetic Prosthetics LOCATION: West Chester, Pennsylvania OWNERS: Mark Nielsen, CP, and Joshua Erickson, CPT HISTORY: Four years

A young patient "adjusts" his socket.

medical biller on staff who regularly takes training courses and adheres to compliance guidelines offered by the American Board for Certification in Orthotics, Prosthetics, and Pedorthics.

Kinetic makes all devices within the facility.

“Communication is much stronger doing fabrication in-house rather than central fab. It can mean more accurate, custom products tailored to each patient. And I can pop into patient rooms whenever I need to,” says Erickson.

The facility has big—and very specific—plans for future growth. Nielsen and Erickson would like to see the practice evolve into a facility where different types of patients, in age as well as ability, can mingle and interact. The space might resemble a small gym where patients could try out different activities and assistive devices.

This “safe space” would allow clients to explore and see what works and what doesn’t, Erickson suggests—with the opportunity

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: Kinetic Prosthetics

Pennsylvania, lives up to its name, with an emphasis on encouraging its clients to take up different types of physical activity. Many patients are inspired to get moving via outdoor or treadmill walking, basketball, cycling, or even indoor skydiving.

“We’re oriented toward activity—trying to use anything possible to get patients out of the house,” says Co-founder Mark Nielsen, CP. “We’ve done walking clinics in local parks that meet once a week, and we promote adaptive sports like kayaking, cycling, and climbing.”

Kinetic’s other founder, Joshua Erickson, CPT, observes, “We try to tie into the community, to give clients fun opportunities to use their devices and get back to the things they were doing before, and to open their eyes to new opportunities.”

Nielsen and Erickson opened Kinetic Prosthetics in July 2013 after both had worked for most of their careers with larger companies. “We both got into the field within a few months of each other,” says Nielsen.

“We’ve worked together a long time and make a good team.”

Kinetic has four employees, with plans to add another shortly.

The 2,500-square-foot facility features a reception area, fitting rooms, a gait room, a casting room, and a laboratory.

The facility has faced familiar O&P growing pains, including staying current with compliance and regulatory issues. Kinetic Prosthetics now has a certified

to adjust or fix the equipment or procedure on the spot.

“People could hop on a bike or a treadmill or pick up a basketball—even try a climbing wall,” he says. “We’d provide all the things patients want to do, but in one spot so they wouldn’t necessarily have to travel to other places.”

Kinetic Prosthetics also takes part in an annual indoor skydiving event. It’s a fun, nonweight-bearing activity open not just to prosthetic patients, Nielsen notes, but to anyone with adaptive needs, such as those with cerebral palsy. “It’s pretty cool to see their smiles and exhilaration to be weightless for a few minutes,” he says.

Kinetic’s marketing efforts involve integrating its outside sports activities and participation in a variety of community events.

The company also partners with such organizations as the Orthotic and Prosthetic Activities Foundation, Paradox Sports for climbing, and the Eastern Amputee Golf Association.

With its focus on sports and other activities, the demographic for Kinetic Prosthetics skews younger than some other O&P facilities. Even so, the company has patients from age 2 to 92.

“Even for someone 92 years old, we want to get them out of the house as much as possible,” says Nielsen. “And for every patient, we pride ourselves on our flexibility and investment in time.”

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MEMBER SPOTLIGHT

FLO-TECH® Orthotic & Prosthetic Systems Inc.

By DEBORAH CONN

Postoperative Priorities Company offers products designed to manage the residual limb

R

OBERT N. (BOB) BROWN

52

FEBRUARY 2018 | O&P ALMANAC

experience—that rigid is better, although there are cases where the opposite may also be true.

FACILITY: “Rigid is generally a safer route FLO-TECH® Orthotic to go,” she says. “It gets patients ambulatory sooner, allows more & Prosthetic frequent access for wound care, Systems Inc. helps to heal more quickly, and prevents further residual injury.”

LOCATION: Bob, a past president of Trumansburg, the American Academy of New York Orthotists and Prosthetists, retired in 2008. He and Kathy, OWNERS: who remains company president, Kathleen E. Brown have relocated to Nevada. Even and Robert N. Brown in retirement, Bob continues Sr., CPO(e), FAAOP to develop new products.

FLO-TECH has five employees HISTORY: in addition to Tiffany and her husband, Travis Mitchell, who 30 years works as the property manager.

The 4,500-square-foot facility features machine, oven, and assembly/packing rooms, plus additional multipurpose spaces.

Tiffany and her husband live on the approximately 50-acre site in a nearby cottage. A baby, born last July, spends time in a nursery tucked into a corner of the office.

Travis Mitchell works in the “With so few of us, we all wear forming room.

many hats and do multiple jobs,” Tiffany says. For example, the office manager, Jill Koczent, works in the assembly room, handles distributor calls, and manages the website. Tiffany handles legal aspects of the business, including compliance with standards from the Occupational Safety and Health Administration and New York state laws.

Traditionally, FLO-TECH has marketed through industry meetings, and Tiffany has plans to market the company more toward individual practitioners.

FLO-TECH plans to introduce a new product developed by Bob, called ProPrep, a Perpetual Dimension prosthetic system for use as a rigid removable dressing, early ambulatory prosthesis, and as a preparatory prosthesis.

Details of the device are under wraps until its launch. “We’re eager to find out more about ProPrep and how it fits into our future plans,” Tiffany says.

She appreciates how much her father, Bob, still contributes to the company after all this time.

Maintaining FLO-TECH’s family feeling, for staff, practitioners, and patients, remains a priority.

Tiffany is eager to immerse herself more deeply in the prosthetics industry and all the details of the product line that FLO-TECH offers. “I’m open to many possibilities,” she says. “We really mean our motto, ‘Life Begins Again.’”

Deborah Conn is a contributing writer to O&P Almanac. Reach her at deborahconn@verizon.net.

PHOTOS: FLO-TECH ® Orthotic & Prosthetic Systems Inc.

first trained in orthotics and prosthetics at the Brooke Army Medical Center in San Antonio to serve as a medic during the Vietnam War. That experience shaped his career. He became a certified O&P practitioner, and with his wife, Kathy, operated a number of patient-care offices throughout the Finger Lakes region of New York.

In the 1990s, Bob patented the Adjustable Post-Operative Preparatory Prosthetic System, or APOPPS®. This three-part prosthesis allows the practitioner to provide a continuum of care from the time of amputation, through early weight bearing, until the patient can begin walking independently. The device can be a vital link in the process of taking patients from amputation to definitive prosthesis.

APOPPS led the Browns to launch FLO-TECH®, a separate company from the patientcare side, which continues to specialize in sockets for immediate postoperative care that allow for early ambulation, effective edema control and knee flexion, improved access for surgical-site care, and postoperative rehabilitation.

“The point is to manage the residual limb,” says Tiffany Brown, Bob and Kathy’s daughter, who is vice president of the company.

She notes that, in the debate over a soft or rigid device for postoperative care, FLO-TECH has generally found—after considerable research and

The FLO-TECH team

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Advance your career.

10. AOPA coding and billing experts have more than 70 years of combined experience.

The San Antonio Marriott Riverwalk 889 E Market St San Antonio, TX 78205

Book your hotel by July 6 for the $149/night rate.

Find the best practices to help you manage your business.

Participate in the 2018 Coding & Billing Seminar!

Register online at bit.ly/2018billing.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org. .

www.AOPAnet.org

AOPA NEWS

AOPAversity Webinars MARCH 14

APRIL 11

Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More

Having trouble with all of the acronyms in the coding guidelines? Plan now to take part in the March 14 webinar, when AOPA experts will explain the following: • Medically Unlikely Edit (MUE) charts • Procedure-To-Procedure (PTP) edit charts • Recommendations from the Pricing, Data Analysis, and Coding (PDAC) contractor • And others.

Enhancing Cash Flow & Increasing Accounts Receivable

Are you maximizing your cash flow and staying up-to-date with accounts receivable (AR)? Plan to participate in the April 11 webinar to access tips and suggestions from AOPA experts on these key topics: • General concepts of AR collection • Basic strategies for AR improvement • When to ask for outside help • How and when things can be written off (co-pays, deductibles, etc.).

AOPA members pay $99 (nonmembers pay $199), and any number of employees may participate on a given line. Attendees earn 1.5 continuing education credits by returning the provided quiz within 30 days and scoring at least 80 percent. Register at bit.ly/2018webinars. Contact Ryan Gleeson at rgleeson@AOPAnet.org or 571/431-0876 with questions.

Your source for advanced learning and CE Credits–

AOPAversity Online 100+ COURSES 54

FEBRUARY 2018 | O&P ALMANAC

EARN CE CREDITS

Sign up for the entire series and get two conferences free. All webinars that you missed will be sent as a recording.

Register at bit.ly/2018webinars.

O&P Care is Cost Effective

new

Visit the MobilitySaves.org!

O&P CARE IS A SAVER, NOT AN EXPENSE TO INSURERS!

5

Reasons to visit MobilitySaves.org

1.

Learn how access to Quality Care improves mobility.

3.

Get Involved by sharing the Mobility Saves story on social media.

2.

See Healthy Lives improved by access to O&P care.

4.

Learn about The Data proving that access to O&P care saves lives.

5.

Learn how orthotic and prosthetic care creates Cost Savings.

Follow us on social media!

Follow “Mobility Saves� on Facebook, Twitter, and LinkedIn

NEW MEMBERS

T

HE OFFICERS AND DIRECTORS of the American Orthotic & Prosthetic Association (AOPA) are pleased to present these applicants for membership. Each company will become an official member of AOPA if, within 30 days of publication, no objections are made regarding the company’s ability to meet the qualifications and requirements of membership.

At the end of each new facility listing is the name of the certified or state-licensed practitioner who qualifies that patient-care facility for membership according to AOPA’s bylaws. Affiliate members do not require a certified or state-licensed practitioner to be eligible for membership.

At the end of each new supplier member listing is the supplier level associated with that company. Supplier levels are based on annual gross sales volume.

Adaptive Technologies LLC / dba Beacon Prosthetics & Orthotics 3224 Lake Woodard Drive, Ste. 100 Raleigh, NC 27604-3659 Member Type: Patient-Care Affiliate Parent Company: Bulow Holdings LLC / dba BCP Group, Nashville, TN 919/231-3490

Alabama Artificial Limb & Orthopedic Service Inc. 1223 East South Blvd.

Montgomery, AL 36116-2315 Member Type: Patient-Care Affiliate Parent Company: Bulow Holdings LLC / dba BCP Group, Nashville, TN 334/280-2853

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FEBRUARY 2018 | O&P ALMANAC

Baker O&P Enterprises Inc. / dba Baker Orthotics & Prosthetics 810 Lipscomb Street Fort Worth, TX 76104-3116 Member Type: Patient-Care Affiliate Parent Company: Bulow Holdings LLC / dba BCP Group, Nashville, TN 817/332-7313

Bulow BioTech Prosthetics LLC / dba Bulow Orthotic & Prosthetic Solutions 100 Kenner Avenue Nashville, TN 37205-2208 Member Type: Patient-Care Affiliate Parent Company: Bulow Holdings LLC / dba BCP Group, Nashville, TN Limb Center LLC / dba The Limb Center 637 E. Cottonwood Lane Casa Grande, AZ 85122 Member Type: Patient-Care Facility 520/413-1554 Dave Sharma, CP

Pacific Medical P&O 1055 N. Curtis Road, Unit 5-6 Boise, ID 83706 Member Type: Patient-Care Affiliate Parent Company: Pacific Medical P&O, Tracy, CA 208/367-4680

Priority Footwear and Pedorthic Services 10240 SW Nimbus Avenue, Ste. L1 Portland, OR 97223 Member Type: Patient-Care Facility 503/524-9656 Kevin Clarke Rocky Mountain Artificial Limb & Brace Inc. 285 Jefferson Avenue Pocatello, ID 83201-3922 Member Type: Patient-Care Affiliate Parent Company: Bulow Holdings LLC / dba BCP Group, Nashville, TN 208/232-6611

The ALLELES Design Studio Ltd. 560 Johnson Street, Ste. 47 Victoria , BC V8W 1M2 Canada Member Type: International 206/207-3033 McCauley Wanner Yanke Bionics Inc. 6100 S. Broadway, Ste. 104 Lorain, OH 44053 Member Type: Patient-Care Affiliate Parent Company: Yanke Bionics Inc. 440/233-4314

O&P PAC UPDATE

Update the O&P PAC Authorization Form for 2018 The O&P PAC Update provides information on the activities of the O&P PAC, including the names of individuals who have made recent donations to the O&P PAC and the names of candidates the O&P PAC has recently supported.

The purpose of the O&P PAC is to advocate for legislative or political interests at the federal level that have an impact on the orthotic and prosthetic community. The O&P PAC achieves this goal by working closely with members of the House and

Senate and other officials running for office to educate them about the issues, and help elect those individuals who support the O&P community.

To participate in, support, and receive additional information about the O&P PAC, federal law mandates that eligible individuals must first sign an authorization form, which may be completed online at bit.ly/pacauth, or you may complete and return the authorization card below. For more information, contact Devon Bernard at dbernard@AOPAnet.org.

O&P PAC Authorization I authorize the O&P PAC to share information with me, executive, administrative, and professional personnel associated with the company designated by me below.

Name: __________________________________________________________________________ Company: _______________________________________________________________________ Address:_________________________________________________________________________ Telephone: ______________________________________________________________________ Email: __________________________________________________________________________ AOPA must obtain the signature of a corporate officer, or a person that can authorize for their company. Signing multiple dates eliminates the need to contact you for authorization approval in upcoming years and reinforces your commitment to the O&P PAC. 2018____________________________________________ 2019____________________________________________ 2020____________________________________________

Return completed form to: AOPA Attn: O&P PAC 330 John Carlyle Street, Ste. 200 Alexandria, VA 22314 Or fax to: 571/431-0899

As required by federal law, my company has not authorized a federal PAC solicitation by another trade association during any calendar year in which this “authorization� is granted to O&P PAC. Signing this card in no way obligates me or others to contribute; it just gives them the opportunity to do so.

O&P ALMANAC | FEBRUARY 2018

57

MARKETPLACE

Feature your product or service in Marketplace.

Contact Bob Heiman at 856/673-4000 or email bob.rhmedia@comcast.net.

Visit bit.ly/almanac18 for advertising options.

ALPS Flex Sleeve

Make More Possible With the New 2018 ‘Crossover’ Knee

ALPS’ new Flex Sleeve (SFX) is a new seamless knitted construction. It features ALPS HD Gel, which has a relatively firm nature and provides maximum comfort while providing a great degree of control.

The SFX has a 30-degree pre-flexion that allows for ease of bending and reduces bunching behind the knee.

For more information, contact ALPS at 800/574-5426 or visit www.easyliner.com.

Robust Lamination Options From College Park The new line of lamination adapters from College Park are made from high-strength, lightweight titanium or stainless steel.

The versatile designs are easy to use with both thermoplastic and laminated sockets, and a one- or two-stage lamination process. Tested as a system for flexibility and durability, kits are available for three-prong, fourprong, and four-ear adapters.

Learn more and order online at college-park.com/lamination.

Coyote Design Adhesives We now have two glues COYOTE ADHESIVES to choose from.

• Coyote Quick Adhesive— Quick Adhesive 30-second set time.

• Coyote Smooth Adhesive— Smooth Adhesive new 60-second set time option.

Coyote’s glues are great for attaching componentry and multiple repairing uses.

They ship nonhazardous and are safe with no odor.

For more information, contact Coyote Design at 208/429-0026 or visit www.coyotedesign.com.

Quick Set Time

NEW GLUE!!!

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FEBRUARY 2018 | O&P ALMANAC

Longer Work Time

The worlds’ first hybrid prosthetic knee that is user adaptable for walking, running, or sports offers the following features and benefits: • Walking knee transforms into an activity knee • Mimics natural muscle function • Adjustable tendon durometers • Adjustable flexion range requiring no tools • Adjustable dampening and rebound • 275 lbs K2- K4+ activity • Use in any environment • Light and strong • Hybrid design.

Call us about our evaluation program! Call 800/322-8324 or visit www.fabtechsystems.com.

AllPro Foot From Fillauer The AllPro foot from Fillauer crosses all boundaries, combining high flexibility and dynamic performance into a foot that allows the user to work and play like a pro. Whether walking on a flat surface or traversing steep hills, the AllPro performs to meet multiaxial needs. If exercise or sports are on your activity list, this “do-it-all” foot easily transitions from the gym to the tennis and basketball courts, as well as the soccer, football, and lacrosse fields. Play like a pro!

For more information, contact Fillauer at 800/251-6398 or visit www.fillauer.com.

Motion Control’s Next Generation ETD2 A U.S. Department of Defense grant, awarded to Motion Control of Salt Lake City, Utah, funded development of a new Electric Terminal Device (ETD) and wrist system.

For many in U.S. military hospitals, the ETD is the first-choice hand replacement for function and versatility. The ETD is the only device that achieves true resistance against water, dirt, dust, and grease.

The next-generation ETD2 is available now. For more information, contact Motion Control, a division of Fillauer, at 888/696-2767 or visit www.UtahArm.com.

MARKETPLACE Custom Sockets When You Need Them Custom sockets and systems are made from your measurements and adhere to the patented design principles established in our standard sizes. Shown here from left to right, Flexion Contracture, Ischial Weight-Bearing Transtibial, Symes, and Knee Disarticulation custom sockets. At FLO-TECH® custom sockets and systems are shipped on the same day as ordered, if order is received prior to Noon Eastern Standard Time.

We also have components for all systems. More info at www.1800flo-tech.com.

LEAP Balance Brace Hersco’s Lower-Extremity Ankle Protection (LEAP) brace is designed to aid stability and proprioception for patients at risk for trips and falls. The LEAP is a short, semirigid ankle-foot orthosis that is functionally balanced to support the foot and ankle complex. It is fully lined with a lightweight and cushioning Velcloth interface, and is easily secured and removed with two Velcro straps and a padded tongue.

For more information, call 800/301-8275 or visit www.hersco.com.

Iceross Seal-In X Options Introducing the new Iceross Seal-In X-Classic, Seal-In X-Volume, and Seal-In X-Grip movable seals. For use with the Seal-In X and Seal-In X TF liners, these seals feature an improved textile donning aid and Easy Glide low-friction coating, making donning the socket easier without the use of alcohol or lubricant spray.

Improve your patients’ skin and limb health, control volume, and reduce pistoning and rotation. Seal-In X provides personalized, optimal fit and secure suspension.

Recommended for use with Unity sleeveless elevated vacuum for excellent volume control and suspension, with minimal added weight and no added build height.

Ask your Össur rep about a demo today! For more information, contact Össur at 800/233-6263 or visit www.ossur.com.

Ottobock’s ProFlex™ Plus Sealing Sleeve Countdown to flexibility for you and your patients with Ottobock’s ProFlex™ Plus Sealing Sleeve • Three colors and sizes • Two lengths • Number one choice.

ProFlex Sleeves—delivering proven performance for the last 10 years.

This soft, yet tough, sealing sleeve is designed with a more flexible fabric and smoother proximal seam. It features 15 degrees of flexion for easier bending and less bunching behind the knee; a preformed knee cap for lower stress on the patella; and a conical shape proximal for improved thigh fit and tighter distal shape for enhanced sealing on socket.

Check out professionals.ottobockus.com for details.

Ottobock’s WalkOn® Carbon-Fiber AFO WalkOn ankle-foot orthoses (AFOs) are prefabricated from advanced prepreg carbon composite material designed to help users with dorsiflexion weakness walk more naturally. WalkOn AFOs are lightweight, low profile, and extremely tough. Their dynamic design can help patients achieve a more physiological and symmetrical gait, offering fluid rollover and excellent energy return. WalkOn offers a full range of AFO sizes and designs, including the WalkOn Reaction Junior pediatric sizes.

Fast and easy to fit, the WalkOn footplate is trimmable and can be shaped with scissors, often requiring only one office visit. Contact us at 800/328-4058 or professionals. ottobockus.com for details.

O&P ALMANAC | FEBRUARY 2018

59

MARKETPLACE Spinal Technology Spinal Technology Inc. is a leading central fabricator of spinal orthotics, upper- and lower-limb orthotics, and prosthetics.

Our ABC-certified staff orthotists/ prosthetists collaborate with highly skilled, experienced technicians to provide the highest quality products and fastest delivery time, including weekends and holidays, as well as unparalleled customer support in the industry.

Spinal Technology is the exclusive manufacturer of the Providence Scoliosis System, a nocturnal bracing system designed to prevent the progression of scoliosis, and the patented FlexFoam™ spinal orthoses.

For information, contact 800/253-7868, fax 888/775-0588, email info@spinaltech.com, or visit www.spinaltech.com.

AOPA Compliance Guide CD—Updated This Compliance Handbook helps patient-care facilities follow the fraud and abuse prevention guidelines recommended by the Office of the Inspector General. This product will assist you in developing a compliance plan for your facility, including guidelines for developing a standard of conduct, billing policies and procedures, and much more. With the help of the AOPA Compliance Handbook CD, you will be able to create an effective audit/ quality assurance program to monitor compliance and conduct introductory training sessions for employees.

• AOPA Compliance Guide CD—Updated: $159 AOPA members, $318 nonmembers Order at www.AOPAnet.org or call AOPA at 571/431-0876.

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FEBRUARY 2018 | O&P ALMANAC

2018 AOPA Coding Products

Get your facility up to speed, fast, on all of the O&P Health-Care Common Procedure Coding System (HCPCS) code changes with an array of 2018 AOPA coding products. Ensure each member of your staff has a 2018 Quick Coder, a durable, easy-to-store desk reference of all of the O&P HCPCS codes and descriptors.

• 2018 Coding Suite (includes CodingPro single user, Illustrated Guide, and Quick Coder): $350 AOPA members, $895 nonmembers • 2018 CodingPro CD-ROM (single-user version): $185 AOPA members, $425 nonmembers • 2018 CodingPro CD-ROM (network version): $435 AOPA members, $695 nonmembers • 2018 Illustrated Guide: $185 AOPA members, $425 nonmembers • 2018 Quick Coder: $30 AOPA members, $80 nonmembers.

Order at www.AOPAnet.org or call AOPA at 571/431-0876.

SUBSCRIBE

A large number of O&P Almanac readers view the digital issue— If you’re missing out, apply for an eSubscription by subscribing at bit.ly/AlmanacEsubscribe, or visit issuu.com/americanoandp to view your trusted source of everything O&P.

CAREERS Southeast

Opportunities for O&P Professionals

CPO, CO

Job location key:

South Carolina

- Northeast - Mid-Atlantic - Southeast - North Central - Inter-Mountain - Pacific

Hire employees and promote services by placing your classified ad in the O&P Almanac. When placing a blind ad, the advertiser may request that responses be sent to an ad number, to be assigned by AOPA. Responses to O&P box numbers are forwarded free of charge.

Include your company logo with your listing free of charge.

Deadline: Advertisements and payments need to be received one month prior to publication date in order to be printed in the magazine. Ads can be posted and updated any time online on the O&P Job Board at jobs.AOPAnet.org. No orders or cancellations are taken by phone. Submit ads by email to landerson@AOPAnet. org or fax to 571/431-0899, along with VISA or MasterCard number, cardholder name, and expiration date. Mail typed advertisements and checks in U.S. currency (made out to AOPA) to P.O. Box 34711, Alexandria, VA 22334-0711. Note: AOPA reserves the right to edit Job listings for space and style considerations.

Floyd Brace Company Inc. is currently seeking hard-working, skilled, certified prosthetic/orthotic practitioners for our South Carolina territory. CPOs and COs must possess a strong clinical background. Compassion, quality, and timeliness of care are important aspects to provide our patients. We offer competitive salary, medical, dental, and vision benefits.

Additionally, retirement plan options are available.

Candidates must possess ABC certification and experience for each discipline.

Contact: Human Resource Department Email: niki@floydbrace.com

For more opportunities, visit: http://jobs.aopanet.org.

ADVERTISERS INDEX

Company

Page

Phone

Website

ALPS

19 800/574-5426

www.easyliner.com

Amfit

13 800/356-3668

www.amfit.com www.anatomicalconceptsinc.com

Anatomical Concepts Inc.

33

800/837-3888

Board of Certification Accreditation

51

877/776-2200

www.bocusa.org

College Park Industries

7

800/728-7950

www.college-park.com

ComfortFit Orthotic Labs Inc.

16

888/523-1600

www.comfortfitlabs.com

Coyote Design

17, 39

800/819-5980

www.coyotedesign.com

Custom Composite

15

866/273-2230

www.cc-mfg.com

Fabtech Systems LLC

49

1-800-FABTECH

www.fabtechsystems.com

Ferrier Coupler Inc.

41

810/688-4292

www.ferrier.coupler.com

Fillauer

9 800/251-6398

www.fillauer.com

FLO-TECH O&P Systems Inc.

43

www.1800flo-tech.com

Hersco

800/356-8324

1 800/301-8275

www.hersco.com

Kingsley Manufacturing Company

47

800/854-3749

www.kingsleymfg.com

Motion Control, division of Fillauer

34, 35

801/326-3434

www.utaharm.com

Naked Prosthetics

45

888/977-6693

www.npdevices.copm

Ă–ssur

5 800/233-6263

Ottobock Spinal Technology Inc.

www.ossur.com

31, C4

800/328-4058

www.professionals.ottobockus.com

27

800/253-7868

www.spinaltech.com O&P ALMANAC | FEBRUARY 2018

61

CALENDAR

2018

March 1

February 14

Inpatient Billing. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

ABC: Application Deadline for Certification Exams.

Applications must be received by March 1 for individuals seeking to take the May Written and Written Simulation certification exams. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

WEBINAR

February 14-17

Academy Annual Meeting & Scientific Symposium. New Orleans.

Visit academyannualmeeting.org.

March 1

ABC: Practitioner Residency Completion Deadline for Spring CPM Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

February 23-24

PrimeFare Central Regional Scientific Symposium 2018.

Renaissance Hotel, Tulsa, OK. Contact Cathie Pruitt, 901/359-3936, email primecarepruitt@gmail.com; or Jane Edwards, 888/388-5243, email jledwards88@att.net; or visit www.primecareop.com.

February 26-27

2018 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars.

Doubletree by Hilton, Atlanta. Register online at bit.ly/2018billing.

For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

March 1

Call for Papers deadline. Deadline to submit your clinical, business, technical papers or symposia at bit.ly/present2018 to present at the 2018 National Assembly.

March 7-8

AOPA Policy Forum. Washington, DC. Come make a difference! Educate Congress on issues affecting your patients. For more information, contact Devon Bernard at dbernard@AOPAnet.org or call 571/431-0876.

March 12-17

ABC: Written and Written Simulation Certification Exams. ABC certification exams will be administered for orthotists, prosthetists, pedorthists, orthotic fitters, mastectomy fitters, therapeutic shoe fitters, orthotic and prosthetic assistants, and technicians in 300 locations nationwide. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

March 14

Medicare Coding Guidelines: MUEs, PTPs, PDAC, and More. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

Apply Anytime!

Apply anytime for COF, CMF, CDME; test when www.bocusa.org ready; receive results instantly. Current BOCO, BOCP, and BOCPD candidates have three years from application date to pass their exam(s). To learn more about our nationally recognized, in-demand credentials, or to apply now, visit www.bocusa.org.

SHARE

your next event!

62

Cascade Dafo Institute. Cascade Dafo Institute offers eight free ABC-approved online continuing education courses for pediatric practitioners. Earn up to 12.25 CE credits.

Visit cascadedafo.com or call 800/848-7332.

CE For information on continuing education credits, contact the sponsor.

Questions? Email landerson@AOPAnet.org.

Calendar Rates Let us

Free Online Training

CREDITS

Phone numbers, email addresses, and websites are counted as single words. Refer to www.AOPAnet.org for content deadlines.

Send announcement and payment to: O&P Almanac, Calendar, P.O. Box 34711, Alexandria, VA 22334-0711, fax 571/431-0899, or email landerson@AOPAnet.org along with VISA or MasterCard number, the name on the card, and expiration date. Make checks payable in U.S. currency to AOPA. Note: AOPA reserves the right to edit calendar listings for space and style considerations.

FEBRUARY 2018 | O&P ALMANAC

Words/Rate

Member

Nonmember

25 or less

$40

$50

26-50

$50 $60

51+

$2.25/word $5.00/word

Color Ad Special 1/4 page Ad

$482

$678

1/2 page Ad

$634

$830

CALENDAR

April 1

ABC: Practitioner Residency Completion Deadline for May Exams. All practitioner candidates have an additional 30 days after the application deadline to complete their residency. Contact 703/836-7114, email certification@abcop.org, or visit www.abcop.org/certification.

April 11

Enhancing Cash Flow & Increasing Your WEBINAR Accounts Receivable. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

April 26-28

New York State Chapter Annual Meeting (NYSAAOP).

Rivers Casino & Resort, Schenectady, NY. For more information, visit www.NYSAAOP.org.

April 30 – May 1

2018 Mastering Medicare: Essential Coding & Billing Seminar Coding & Billing Techniques Seminars.

San Antonio, TX. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

May 9

Coding: Understanding the Basics.

WEBINAR Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

September 12

Medicare As a Secondary Payor: Knowing the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

September 26-29

AOPA National Assembly. Vancouver Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

October 10

Year-End Review: What Should You Do To Wrap Up the Year & Get Ready for the New Year. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

November 4-10

Health-Care Compliance & Ethics Week.

AOPA is celebrating Health-Care Compliance & Ethics Week and is providing resources to help members celebrate.

Learn more at bit.ly/aopaethics.

November 12-13

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

Las Vegas. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

June 13

Audits: Know the Types, Know the Players, and Know the Rules. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

November 14

Evaluating Your Compliance Plan & Procedures: How To Audit Your Practice.

Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

July 11

Administrative Documentation: The Must Haves and the Sometimes Needed. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

December 12

New Codes, Medicare Changes, & Updates. Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

July 23-24

2018 Mastering Medicare: Essential Coding & Billing Techniques Seminars.

St. Louis, MO. Register online at bit.ly/2018billing. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

Coding & Billing Seminar

August 8

Outcomes & Patient Satisfaction Surveys.

Register online at bit.ly/2018webinars. For more information, email Ryan Gleeson at rgleeson@AOPAnet.org.

WEBINAR

2019 September 25-28

AOPA National Assembly. San Diego Convention Center. For general inquiries, contact Ryan Gleeson at 571/431-0876 or rgleeson@AOPAnet.org, or visit www.AOPAnet.org.

O&P ALMANAC | FEBRUARY 2018

63

ASK AOPA CALENDAR

What Constitutes Medical Necessity?

Rules for coverage of replacement devices and liners

AOPA receives hundreds Q of queries from readers and members who have questions about some aspect of the O&P industry. Each month, we’ll share several of these questions and answers from AOPA’s expert staff with readers.

If you would like to submit a question to AOPA for possible inclusion in the department, email Editor Josephine Rossi at jrossi@contentcommunicators.com.

Q/

What is the useful lifetime for prosthetics?

Traditionally, the useful lifetime is defaulted to five years.

However, a section of the Benefits Improvement and Protection Act of 2000 (BIPA) states, “Payment shall be made for the replacement of prosthetic devices … or for the replacement of any part of such devices, without regard to continuous use or useful lifetime restrictions… .”

This, in essence, means that there are no useful lifetime restrictions in place for prosthetics, but the act also points out that there must be solid justification for anything being replaced that is less than three years old.

A/

Is it true that the need for a replacement can be listed on the order/prescription, and this would be accepted documentation?

Q/

Yes, in very limited circumstances. The Lower-Limb Prostheses Policy includes this statement: “The reason for replacement must be documented by the treating physician, either on the order or in the medical record… .”

A/

Is it true that Medicare only covers two prosthetic liners every six months?

Q/

No. The Lower-Limb Prostheses Policy states, “No more than two of the same socket inserts (L5654-L5665, L5673, L5679, L5681, and L5683) are allowed per individual prosthesis at the same time.”

The policy doesn’t limit when the liners may be replaced. If the replacement liners are medically necessary, they may be replaced at any time.

A/

Is the user-adjustable heel height (L5990) a noncovered code or service?

Q/

No. The user-adjustable heel height is not a noncovered code, but it will be denied as not medically necessary. This means that you may receive payment and coverage if you can demonstrate that it is medically necessary for the beneficiary.

A/

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FEBRUARY 2018 | O&P ALMANAC

Why should you attend?

The Policy Forum is your

BEST OPPORTUNITY

to learn the latest legislative and regulatory details and how they will affect you, your business and your patients.

Once you are armed with the facts, we as a profession will educate our members of Congress to offer common sense solutions and share how the O&P profession restores lives and puts people back to work.

Questions regarding registration, travel or the agenda should be directed to Ryan Gleeson at rgleeson@AOPAnet.org or (571) 431-0876. Questions regarding programming, congressional visits or key issues should be directed to Devon Bernard at dbernard@AOPAnet.org or (571) 431-0854.

HOST HOTEL: Ritz Carlton, 1250 South Hayes Street, Arlington, VA 22202 AOPA has a special rate of $279/night until February 16.

Meet your member of Congress and tell them how, through orthotics and prosthetics:

Educate lawmakers on the issues that are important to YOU: •

Ensure that veterans maintain the ability to receive care from their chosen provider

•

Make sure O&P remains an Essential Health Benefit

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Prevent the expansion of off-the-shelf orthoses and competitive bidding

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Recognizing the orthotist’s/ prosthetist’s notes as part of the medical record in Medicare medical necessity determinations

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To advance the recognition of criteria which underscore that qualified providers are the ones who can treat patients most effectively, with best outcomes.

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Cyberspine TLSOx4 Universal sizing now available

Easy to don and doff

Universal sizing reduces inventory and overall costs Tool free adjustment and low-profile design

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Patented Mechanical Advantage Pulley System maximizes spinal stabilization and abdominal compression